J Korean Ophthalmol Soc.  2016 Dec;57(12):1857-1865. 10.3341/jkos.2016.57.12.1857.

Evaluation of Changes in Tear Film Lipid Layer Thickness Using Ocular Surface Interferometer after Artificial Tear Application

• Kim SH
• Park SY
• Ji YW
• Seo KY
• Kim EK
• Kim TI

• KMID: 2362702
• DOI: http://doi.org/10.3341/jkos.2016.57.12.1857

Abstract

PURPOSE
The changes in tear film lipid layer thickness (LLT) after artificial tears application using LipiView®II interferometer were assessed.
METHODS
We performed a prospective study of patients with dry eye disease. All subjects underwent measurement of tear film break-up time, Schirmer test, ocular surface staining, meibomian gland evaluation, and subjective score assessment using the Ocular Surface Disease Index. All subjects were randomly assigned to 1 of 3 groups using table of random numbers (group 1, sodium hyaluronate [HA] 0.1% eye drops without preservatives; group 2, HA 0.3% eye drops without preservatives and group 3, HA 0.1% with benzalkonium chloride 0.003%). LLT was measured before, immediately after and 1 hr, 3 hrs, and 6 hrs after artificial tears application. Additionally, the patients were divided into 2 subgroups depending on the presence of meibomian gland dysfunction (MGD) and further evaluated.
RESULTS
Significant change in LLT was observed at 3 hrs after artificial tears instillation. LLT in groups 1 and 2 showed significant changes over time (p < 0.01 and p < 0.01, respectively). However, LLT in group 3 showed no change. LLT was unchanged in patients without MGD. Conversely, in MGD patients, a significant difference in LLT between groups 1 and 2 was observed immediately after and 1 hr and 3 hrs after instillation of artificial tears (p = 0.04, p < 0.01 and p = 0.02, respectively) but not at 6 hrs. However, no significant difference in LLT between groups 1 and 3 was observed in MGD patients.
CONCLUSIONS
LLT after instillation of artificial tears measured using LipiView®II interferometer was affected by artificial tear concentration and presence of preservatives. Additionally, the presence of MGD can impact the pattern of LLT changes induced by artificial tear instillation. Therefore, LLT measurements using LipiView®II interferometer require at least a 6-hrs interval after use of eye drops, especially for patients with MGD or using artificial tears with preservatives.

Keyword

Artificial tears; Dry eye disease; LipiView®II interferometer; Meibomian gland dysfunction; Tear film lipid layer thickness

MeSH Terms

Benzalkonium Compounds
Eye Diseases
Humans
Hyaluronic Acid
Lubricant Eye Drops
Meibomian Glands
Ophthalmic Solutions
Prospective Studies
Tears*
Benzalkonium Compounds
Hyaluronic Acid
Lubricant Eye Drops
Ophthalmic Solutions

Figure

• 

  Figure 1. Schematic diagram of the study protocol. 84 patient were screened and total 56 patients were included. All subjects underwent measurement of tear film break-up time (TBUT), Schirmer test, ocular surface staining, meibomian gland evaluation, and subjective score assessment using Ocular Surface Disease Index (OSDI). Patients were randomly assigned to 1 of 3 groups using table of random numbers. Lipid layer thickness (LLT) was measured before, immediately after and 1 hr, 3 hrs, and 6 hrs after artificial tears application. HA = sodium hyaluronate; h(s) = hour(s).

• 

  Figure 2. The analyzed image by Lipiview®II interferometer. The values are given in interferometric color units (ICUs) where in 1 ICU approximately reflects 1nm of the tear lipid layer thickness (LLT). The average LLT of this patient was 99 ICUs.

• 

  Figure 3. Box plot of lipid layer thickness (LLT) stratified by (A) non-Meibomian gland dysfunction (MGD) group and (B) MGD group. Horizontal lines in the boxes indicate the median; box limits show third quartile and first quartile. Maximum and minimum values are indicated by the top and the bottom whisker ends, respectively. Overall p-values were calculatedby linear mixed model. h(s) = hour(s).

• 

  Figure 4. Box plots of lipid layer thickness (LLT) for comparison between two groups of Meibomian gland dysfunction patients. Figure (A) shows comparision between Group 1 and 2 and figure (B) shows Comparision berween Group 1 and 3. Horizontal lines in the boxes indicate the median; box limits show third quartile and first quartile. Outliers (1.5 × 3 interquartile ranges) are indicated as circles. Maximum and minimum values are indicated by the top and the bottom whisker ends, respectively. p-values were calculated by Linear mixed model. h(s) = hour(s).

Reference

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