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Correlation Between Optical Coherence Tomography–Derived Assessments of Lower Tear Meniscus Parameters and Clinical Features of Dry Eye Disease

Nguyen, Pho MD; Huang, David MD, PhD; Li, Yan PhD; Sadda, Srinivas R. MD; Ramos, Sylvia; Pappuru, Rajeev R. MD; Yiu, Samuel C. PhD, MD

doi: 10.1097/ICO.0b013e3182261577
Basic Investigation

Purpose: To measure the correlation between subjective symptom score, conventional clinical tests, and Fourier-domain optical coherence tomography (FD-OCT) of lower tear meniscus parameters in patients with dry eye disease.

Methods: Eighteen patients with dry eye disease requiring medical therapy and/or punctal occlusion were recruited for this prospective, nonrandomized, observational case series. Severity of symptoms of dry eye disease was assessed using the Indiana University Dry Eye Questionnaire 2002. Clinical assessments were completed using slit-lamp biomicroscopy, rose bengal dye staining, fluorescein tear breakup time (TBUT), and a 5-minute Schirmer test with topical anesthesia. The lower tear meniscus was imaged using an FD-OCT system with 5-μm axial resolution and measured manually by a masked grader using computer calipers. Correlation was assessed using Spearman correlation coefficient (ρ).

Results: The mean (±SD) scaled symptom score was 58 ± 21, with a range of 0 to 100. Vital staining test averaged 1.7 ± 3.4, TBUT averaged 4.4 ± 1.8 seconds, and Schirmer tests averaged 10.2 ± 8.1 mm. As determined by optical coherence tomography, the meniscus height was 228 ± 153 μm, depth was 127 ± 79 μm, and cross-sectional area was 0.018 ± 0.021 mm2. Optical coherence tomography meniscus area was negatively correlated with the symptom questionnaire score (P < 0.01) and positively correlated with Schirmer test results (P < 0.01). There was no significant correlation between symptom score and rose bengal staining, TBUT, or Schirmer test results (P > 0.01).

Conclusions: Lower tear meniscus measurement with FD-OCT is an objective noninvasive test that correlates well with symptoms of dry eye disease and the Schirmer test.

*Doheny Eye Institute, and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA

Casey Eye Institute and Department of Ophthalmology, Oregon Health and Science University, Portland, OR.

Supported by R01EY018184, R24EY13015, research grant from Optovue, Inc, grant from Research to Prevent Blindness, and Charles C. Manger III, MD, Chair in Corneal Laser Surgery endowment. The sponsors and funding agencies had no role in the design or conduct of this research. D. Huang received stock options, patent royalty, and travel support from Optovue, Inc (Fremont, CA). D. Huang and Y. Li received research grant support from Optovue, Inc. S. R. Sadda received research support from Optovue, Inc. Sylvia Ramos, Rajeev R. Pappuru and Samuel C. Yiu do not have any financial interest in the topic of this article.

Reprints: David Huang, Casey Eye Institute, 3375 Southwest Terwilliger Boulevard, Portland, OR 97239-4197 (e-mail:

Received March 4, 2011

Accepted May 24, 2011

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.