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Evaluation of Lipid Layer Thickness Measurement of the Tear Film as a Diagnostic Tool for Meibomian Gland Dysfunction

Finis, David MD; Pischel, Nadja MS; Schrader, Stefan MD, PhD; Geerling, Gerd MD

doi: 10.1097/ICO.0b013e3182a7f3e1
Clinical Science

Purpose: The LipiView interferometer (TearScience Inc, Morrisville, NC) is capable of delivering quantitative values of the tear-film lipid layer thickness (LLT). The purpose of this study was to investigate whether there is a correlation between the LLT and other diagnostic criteria for Meibomian gland dysfunction (MGD).

Methods: We performed a retrospective analysis of 110 patients (199 eyes) from our dry eye clinic. Subjective symptoms, break-up time (BUT), expressible Meibomian glands, and LLT were measured.

Results: There was a significant correlation between expressible Meibomian glands and LLT (r = 0.36, P < 0.0001). Also, a possible trend of inverse correlation between subjective symptoms (standard patient evaluation of eye dryness) and the LLT was observed; however, this was not significant (r = −0.13, P < 0.08). Analysis of the whole study collective revealed no correlation between the BUT and the LLT (r = 0.003, P = 0.97). A subgroup analysis of the patients with an LLT ≤ 60 showed a better correlation between the LLT and the BUT, which was marginally not significant (r = 0.21; P = 0.059). For a cut-off value of ≤75-nm LLT, we found a sensitivity of 65.8% and a specificity of 63.4% for the detection of an MGD. For a cut-off value of ≤60, the sensitivity was 47.9%, and the specificity was 90.2%.

Conclusions: The positive correlation between the LLT and expressible meibomian glands found in this study suggests a higher probability of MGD in patients with a low LLT. This automated assessment of the LLT might be a suitable screening test for detecting MGD. However, further prospective studies are needed to confirm these results and to identify potential confounders.

Department of Ophthalmology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.

Reprints: David Finis, Department of Ophthalmology, Heinrich-Heine-University Düsseldorf, Mooren St 5, Düsseldorf 40225, Germany (e-mail:

The interferometer used in this study was provided by the company TearScience.

The authors have no conflicts of interest to disclose.

S. Schrader and G. Geerling contributed equally to this study.

Received June 07, 2013

Accepted August 02, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.