第四代傅立叶域前节OCT（FD-OCT）在泪河测量及干眼诊断中的应用研究
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摘要
干眼是由于各种原因引起的泪液以及角结膜上皮损伤的慢性疾患,病因较为复杂,临床上极易误诊。干眼诊断标准的精确性及诊断方法的变异性均是造成误诊的主要原因。因此,寻找一种可重复性好、操作便捷的的干眼诊断方法显得尤为重要。随着光学相干断层成像术(optical coherence tomography,OCT)在眼前节应用的拓展及技术的进一步发展,第四代傅立叶域(Fourier domain,FD)OCT所具有的高分辨率、高速度等一系列的特点超越了以往的时域(Time domain,TD)OCT,其所具有的高分辨率眼前节成像功能使其在泪河(tear meniscus)测量方面的应用引起了研究者的广泛关注,但目前尚未有关于第四代傅立叶域OCT在诊断干眼上的效力及正常人泪河方面的研究。因此,本研究对第四代傅立叶域前节OCT应用于泪河成像及测量进行研究,选择了不同年龄段、不同类型干眼患者,同时选择正常人作为对照,探讨第四代傅立叶域前节OCT测量泪河在诊断干眼方面的作用,明确傅立叶域前节OCT应用于何种干眼症类型具有更高的诊断效力;同时对正常对照组按照年龄进行分组,以研究正常人泪河生理值的年龄变化规律。研究结果表明,第四代傅立叶域前节OCT能够对泪河横截面进行清晰成像并进行精确测量,与临床诊断干眼的检查方法(BUT、Schirmer试验)存在良好的诊断一致性,能够直观的反映泪河情况。作为一种无创非接触性、操作简单的检查方法,第四代傅立叶域前节OCT在干眼诊断尤其是水液缺乏型干眼的诊断方面具有良好的应用前景。
第一部分傅立叶域前节OCT在泪河成像及测量的应用研究
目的研究第四代傅立叶域前节OCT(FD-OCT)应用于泪河成像及测量方面的作用。
方法选择我院门诊主诉符合干眼的146例(146眼)患者,同时选取正常志愿者160例(160眼)进行对照,采用傅立叶域(Fourier domain)技术的OCT(RTVue-100)对全部入组者进行泪河高度(TMH)、泪河深度(TMD)及泪河横截面面积(TMA)的测量,结合BUT、角膜荧光素染色及Schirmer试验,并对入组者进行《干眼量表》的评分,对傅立叶域前节OCT泪河成像及测量泪河生理值的可重复性进行分析。
结果干眼组的TMH、TMD、TMA平均值分别为232.319±17.549(μm)、151.494±12.811(μm)、0.024428±0.003712(mm~2),正常对照组TMH、TMD、TMA平均值分别为328.113±19.036(μm)、220.906±12.935(μm)、0.045618±0.005623(mm~2)。干眼组泪河各数值均明显小于正常对照组,差异具有统计学意义(TMHt=12.2646,P=0.0000,TMD t=12.0567,P=0.0000,TMA t=10.1556,P=0.0000)。对两组的个体间变异度进行分析的结果显示,干眼组其泪河测量数值的变异度相对较小,而正常对照组的泪河测量值变异度相对较大。对两组的OCT测量可重复性进行分析的结果显示,两组数值的个体内变异度均较小,说明第四代傅立叶域OCT测量泪河的可重复性良好。干眼组及正常对照组的OCT图像在泪河边界线、泪河横截面积、泪液透明度等方面有较大的差别。
结论第四代傅立叶域OCT能够对泪河横截面进行清晰成像并进行精确测量,可重复性好,能够直观的反映泪河情况。干眼患者泪河测量值明显小于正常对照组,在OCT图像上也与正常组有较大差别。
第二部分正常人群的泪河生理值及其年龄变化规律
目的采用第四代傅立叶域前节OCT(FD-OCT)观察泪河的相关年龄变化及评价FD-OCT在干眼诊断方面的作用。
方法选择干眼患者146例(146眼)及正常志愿者160例(160眼)进行对照,按年龄分为四组:A组(0-19岁),B组(20-39岁),C组(40-59岁),D组(大于60岁);干眼患者各组人数依次为6,60,60,20人,正常对照各组人数依次20,60,60,20人。采用傅立叶域(Fourier domain)技术的第四代高分辨率OCT(RTVue-100)对全部入组者进行泪河高度(TMH)、泪河深度(TMD)及泪河横截面面积(TMA)的测量,结合BUT、角膜荧光素染色及Schirmer试验,并对入组者进行《干眼量表》评分。对上述检查结果的相关性进行分析,得出各年龄段的泪河生理值,绘制ROC曲线,进一步评价第四代傅立叶域前节OCT在诊断干眼方面的应用。
结果对临床检查结果进行spearman相关分析结果显示泪河的各个数值均与个体的症状及临床检查结果存在一定的相关性。干眼组临床检查结果、泪河测量值均与正常对照组之间存在较大的差异。泪河各数值与年龄呈负相关关系(TMH r=—0.0649,p=0.000,TMD r=—0.0299,p=0.0024,TMA r=—0.0320,p=0.0017)。OCT正确诊断干眼的总体比例分别为TMH 68.95%、TMD 70.59%、TMA 70.92%。各年龄段的正确诊断比例亦不相同。ROC曲线下面积(AUC)总体结果显示,TMH为0.7337,TMD为0.7477,TMA为0.7461。各年龄段的AUC之间存在一定的差异。总体诊断界值TMH为259(μm),TMD为165.6667(μm),TMA为0.024(mm~2),各组诊断界值随年龄的增大而下降。
结论第四代傅立叶域前节OCT能够直观的反映泪河生理值的相关年龄变化,与临床诊断干眼的检查方法(BUT、Schirmer试验)存在较好的诊断一致性,各年龄段的诊断效力与诊断界值存在一定的差异。
第三部分傅立叶域前节OCT在干眼症诊断方面的作用
目的采用第四代傅立叶域前节OCT(FD-OCT)测量各类型干眼症患者泪河数值,评价其在干眼诊断方面的作用。
方法选择干眼(DE组)患者146例(146眼),单纯水液缺乏型干眼(ATD组)患者102例(102眼),单纯脂质缺乏型干眼(LTD组)患者81例(81眼),Sj(o|¨)gren综合征(SS组)患者53例(53眼),同时选择正常对照(N组)160例(160眼)进行比较。采用傅立叶域(Fourier domain)技术的第四代高分辨率OCT(RTVue-100)对全部入组者进行泪河高度(TMH)、泪河深度(TMD)及泪河横截面面积(TMA)的测量,结合BUT、角膜荧光素染色及Schirmer试验,并对入组者进行《干眼量表》评分。绘制ROC曲线,评价第四代傅立叶域前节OCT在诊断各类型干眼方面的应用。
结果对临床检查结果进行数据分析显示,各组的各项数据平均值之间存在较大差异。对各组的诊断效力进行分析的结果显示,SS组诊断效力最高,TMH91.19%、TMD 92.51%、TMA92.51%:LD组最低,TMH45.49%、TMD67.06%、TMA46.27%;DE组与ATD组相似。计算TMA的ROC曲线下面积(AUC)结果显示,DE组为0.7855,AD组为0.7110,LD组为0.5279,SS组为0.9706。
结论第四代傅立叶域OCT能够精确测量各种类型干眼症的泪河数据,与临床诊断干眼的检查方法(BUT、Schirmer试验)存在良好的诊断一致性。作为一种无创非接触性、操作简单的检查方法,第四代傅立叶域前节OCT在干眼诊断尤其是水液缺乏型干眼的诊断方面具有良好的应用前景。
Dry eye is caused by a variety of reasons,as well as tear deficiency,corneal or conjunctival epithelial damage as chronic disorders.The cause is more complex, clinically misdiagnosed easily.The reproducibility of dry eye diagnostic criteria is not satisfied and there are many factors to interfere the results.So it is very important to search for a rapid and reliable method for diagnosis of dry eye.With the development of optical coherence tomography(optical coherence tomography,OCT) and further application in anterior segment,the fourth-generation Fourier domain(Fourier domain) OCT has beyond the characteristics of the previous time-domain(Time domain) OCT with high resolution and high speed.It has led to widespread concern researchers with a high-resolution functional imaging of anterior segment of tear meniscus.However, there is no research on the effectiveness of the Fourier-domain OCT in the diagnosis of dry eye and normal tear meniscus area.Therefore,this study will probe on the diagnostic effectiveness and tear meniscus imaging of fourth-generation Fourier domain OCT.We enroll in different ages,different types of dry eye patients,as well as normal controls to explore diagnostic effectiveness of Fourier domain OCT,in order to identify the type of dry eye which has a higher diagnostic effect.At the same time,we make the normal control group into Sub-groups in accordance with age to investigate age-related variations of human tear meniscus in Chinese.The results show that the fourth generation Fourier domain OCT can clearly image and measure the cross-sectional tear meniscus.It also has a good consistency with clinical diagnosis of dry eye examination(BUT,Schirmer test).As a non-invasive,non-contact,simple screening method,the fourth generation Fourier-domain OCT has a good application prospects in the diagnosis of dry eye,especially in aqueous tear deficiency.
PartⅠResearch on the tear meniscus imaging and measurement of the anterior segment Fourier domain OCT
Objective To discuss the utilization of the fourth generation anterior segment Fourier domain optical coherence tomography in the imaging and measurement of tear meniscus
Methods We enrolled 146 cases(146 eyes) and 160 controls(160 eyes) in this study. The tear meniscus height(TMH),tear meniscus depth(TMD) and tear meniscus area (TMA) of each participant were measured by Fourier domain OCT(RTVue-100).We also estimated the tear break up time(BUT),performed the cornea fluorescein staining and Schirmer test,and recorded score of the dry eye questionnaire.The variability of the fourth generation anterior segment Fourier domain OCT in tear meniscus imaging and measurement was discussed.
Results The average values of TMH,TMD and TMA in the patient group were 232.319±17.549(μm)、151.494±12.811(μm)、0.024428±0.003712(mm2), comparing with 328.113±19.036(μm)、220.906±12.935(μm)、0.045618±0.005623(mm2) in the control group,the difference of which reached significant (TMH t=12.2646,P=0.0000,TMD t=12.0567,P=0.0000,TMA t=10.1556, P=0.0000).The individual variability of the TMH,TMD and TMA in the patient group was less than the control group.The repeatability analysis showed a small variation in measurement.The OCT images of the bound and cross section area of the tear meniscus and the clarity of the tear fluid in the patient group were obviously different from those in the control group.
Conclusion The fourth generation Fourier domain anterior segment optical coherence tomography can clearly image and measure the cross section of tear meniscus,the result of which showed a good coherence with the traditional diagnostic test(BUT,Schirmer test) and directly reflect features of the tear meniscus.
PartⅡAge-Related Variations of Human Tear Meniscus in Chinese
Objective To investigate age-related variations of human tear meniscus in Chinese and diagnosis of dry eye using Fourier domain anterior segment OCT.
Methods.We enrolled 146 cases(146 eyes) and 160 controls(160 eyes) in this study.All the subjects in these two groups were divided into four subgroups according to different ages,respectively,group A(0～19),group B(20～39),group C (40～59) and group D(over 60).Dry eye patients have 6,60,60,20 in each group, normal controls have 6,60,60,20 in each group.The tear meniscus height(TMH),tear meniscus depth(TMD) and tear meniscus area(TMA) of each participant were measured by Fourier domain OCT(RTVue-100).We also estimated the tear break up time(BUT),performed the cornea fluorescein staining and Schirmer test,and recorded score of the dry eye questionnaire.The relativity of the clinical examinations was tested,the tear meniscus of the two groups were measured and ROC curves were drawn.
Results There is a significant correlation among tear meniscus values,individual syndrome and clinical diagnoses.The mean TMH、TMD、TMA for dry-eye patients were significantly lower than those for control groups.There was negative correlation between tear meniscus values and age for Chinese healthy subjects(TMH r=-0.0649,p=0.000,TMD r=-0.0299,p=0.0024,TMA r=-0.0320,p=0.0017).The accuracy of the diagnosis of dry eye by Fd-OCT was TMH 68.95%、TMD 70.59%、TMA 70.92%.It's different between the age sub-groups.Area under the ROC curve (AUC) showed that overall,TMH to 0.7337,TMD is 0.7477,TMA is 0.7461.AUC of all ages there are some differences between.TMH Diagnostic value of the overall community for the 259(μm),TMD for 165.6667(μm),TMA was 0.024(mm2),the diagnosis of all ages increase community values decline with age.
Conclusions Fd-OCT could instantly imply the age-related variations of human tear meniscus and has good consistency with the clinical diagnose examinations.It has different diagnostic accuracy in each age sub-group.
PartⅢThe utilization of the fourth generation Fourier domain anterior segment OCT(FD-OCT) in the diagnosis of dry eye
Objective To discuss the utilization of the fourth generation anterior segment Fourier domain OCT in the diagnosis of different types of dry eye patients.
Methods We enrolled 146 cases(146 eyes)of dry eye patients(DE group),102 cases(102 eyes)of aqueous tear deficiency patients(ATD group),81 cases(81 eyes)of lipid tear deficiency patients(LTD group),53 cases(53 eyes)of Sj(o|¨)gren syndrome patients(SS group)and 160 controls(160 eyes) in this study.The tear meniscus height (TMH),tear meniscus depth(TMD) and tear meniscus area(TMA) of each participant were measured by Fourier domain OCT(RTVue-100).We also estimated the tear break up time(BUT),performed the cornea fluorescein staining and Schirmer test,and recorded score of the dry eye questionnaire.The relativity of the clinical examinations was tested,the tear meniscus of the two groups were measured and ROC curves were drawn.
Results The average values of clinical measurements in the patient group were quite different.The results of the diagnostic effectiveness for each group showed,SS group had the highest diagnostic effectiveness,TMH 91.19%,TMD 92.51%,TMA 92.51%; LD group had the lowest,TMH 45.49%,TMD 67.06%,TMA 46.27%.DE group was almost the same with ATD group.The area under the ROC curve(AUC) of TMA showed,DE group was 0.7855,AD group was 0.7110,LD group was 0.5279,SS group was 0.9706.
Conclusion The fourth generation Fourier domain anterior segment optical coherence tomography can accurately measure all types of dry eye tears meniscus,, the result of which showed a good coherence with the traditional diagnostic test(BUT, Schirmer test) and directly reflect features of the tear meniscus.As a non-traumatic and non-contact technique,the fourth generation Fourier domain anterior segment OCT has a favorable prospect in the diagnosis of dry eye,especially in aqueous tear deficiency.
第一部分傅立叶域前节OCT在泪河成像及测量的应用研究
目的研究第四代傅立叶域前节OCT(FD-OCT)应用于泪河成像及测量方面的作用。
方法选择我院门诊主诉符合干眼的146例(146眼)患者,同时选取正常志愿者160例(160眼)进行对照,采用傅立叶域(Fourier domain)技术的OCT(RTVue-100)对全部入组者进行泪河高度(TMH)、泪河深度(TMD)及泪河横截面面积(TMA)的测量,结合BUT、角膜荧光素染色及Schirmer试验,并对入组者进行《干眼量表》的评分,对傅立叶域前节OCT泪河成像及测量泪河生理值的可重复性进行分析。
结果干眼组的TMH、TMD、TMA平均值分别为232.319±17.549(μm)、151.494±12.811(μm)、0.024428±0.003712(mm~2),正常对照组TMH、TMD、TMA平均值分别为328.113±19.036(μm)、220.906±12.935(μm)、0.045618±0.005623(mm~2)。干眼组泪河各数值均明显小于正常对照组,差异具有统计学意义(TMHt=12.2646,P=0.0000,TMD t=12.0567,P=0.0000,TMA t=10.1556,P=0.0000)。对两组的个体间变异度进行分析的结果显示,干眼组其泪河测量数值的变异度相对较小,而正常对照组的泪河测量值变异度相对较大。对两组的OCT测量可重复性进行分析的结果显示,两组数值的个体内变异度均较小,说明第四代傅立叶域OCT测量泪河的可重复性良好。干眼组及正常对照组的OCT图像在泪河边界线、泪河横截面积、泪液透明度等方面有较大的差别。
结论第四代傅立叶域OCT能够对泪河横截面进行清晰成像并进行精确测量,可重复性好,能够直观的反映泪河情况。干眼患者泪河测量值明显小于正常对照组,在OCT图像上也与正常组有较大差别。
第二部分正常人群的泪河生理值及其年龄变化规律
目的采用第四代傅立叶域前节OCT(FD-OCT)观察泪河的相关年龄变化及评价FD-OCT在干眼诊断方面的作用。
方法选择干眼患者146例(146眼)及正常志愿者160例(160眼)进行对照,按年龄分为四组:A组(0-19岁),B组(20-39岁),C组(40-59岁),D组(大于60岁);干眼患者各组人数依次为6,60,60,20人,正常对照各组人数依次20,60,60,20人。采用傅立叶域(Fourier domain)技术的第四代高分辨率OCT(RTVue-100)对全部入组者进行泪河高度(TMH)、泪河深度(TMD)及泪河横截面面积(TMA)的测量,结合BUT、角膜荧光素染色及Schirmer试验,并对入组者进行《干眼量表》评分。对上述检查结果的相关性进行分析,得出各年龄段的泪河生理值,绘制ROC曲线,进一步评价第四代傅立叶域前节OCT在诊断干眼方面的应用。
结果对临床检查结果进行spearman相关分析结果显示泪河的各个数值均与个体的症状及临床检查结果存在一定的相关性。干眼组临床检查结果、泪河测量值均与正常对照组之间存在较大的差异。泪河各数值与年龄呈负相关关系(TMH r=—0.0649,p=0.000,TMD r=—0.0299,p=0.0024,TMA r=—0.0320,p=0.0017)。OCT正确诊断干眼的总体比例分别为TMH 68.95%、TMD 70.59%、TMA 70.92%。各年龄段的正确诊断比例亦不相同。ROC曲线下面积(AUC)总体结果显示,TMH为0.7337,TMD为0.7477,TMA为0.7461。各年龄段的AUC之间存在一定的差异。总体诊断界值TMH为259(μm),TMD为165.6667(μm),TMA为0.024(mm~2),各组诊断界值随年龄的增大而下降。
结论第四代傅立叶域前节OCT能够直观的反映泪河生理值的相关年龄变化,与临床诊断干眼的检查方法(BUT、Schirmer试验)存在较好的诊断一致性,各年龄段的诊断效力与诊断界值存在一定的差异。
第三部分傅立叶域前节OCT在干眼症诊断方面的作用
目的采用第四代傅立叶域前节OCT(FD-OCT)测量各类型干眼症患者泪河数值,评价其在干眼诊断方面的作用。
方法选择干眼(DE组)患者146例(146眼),单纯水液缺乏型干眼(ATD组)患者102例(102眼),单纯脂质缺乏型干眼(LTD组)患者81例(81眼),Sj(o|¨)gren综合征(SS组)患者53例(53眼),同时选择正常对照(N组)160例(160眼)进行比较。采用傅立叶域(Fourier domain)技术的第四代高分辨率OCT(RTVue-100)对全部入组者进行泪河高度(TMH)、泪河深度(TMD)及泪河横截面面积(TMA)的测量,结合BUT、角膜荧光素染色及Schirmer试验,并对入组者进行《干眼量表》评分。绘制ROC曲线,评价第四代傅立叶域前节OCT在诊断各类型干眼方面的应用。
结果对临床检查结果进行数据分析显示,各组的各项数据平均值之间存在较大差异。对各组的诊断效力进行分析的结果显示,SS组诊断效力最高,TMH91.19%、TMD 92.51%、TMA92.51%:LD组最低,TMH45.49%、TMD67.06%、TMA46.27%;DE组与ATD组相似。计算TMA的ROC曲线下面积(AUC)结果显示,DE组为0.7855,AD组为0.7110,LD组为0.5279,SS组为0.9706。
结论第四代傅立叶域OCT能够精确测量各种类型干眼症的泪河数据,与临床诊断干眼的检查方法(BUT、Schirmer试验)存在良好的诊断一致性。作为一种无创非接触性、操作简单的检查方法,第四代傅立叶域前节OCT在干眼诊断尤其是水液缺乏型干眼的诊断方面具有良好的应用前景。
Dry eye is caused by a variety of reasons,as well as tear deficiency,corneal or conjunctival epithelial damage as chronic disorders.The cause is more complex, clinically misdiagnosed easily.The reproducibility of dry eye diagnostic criteria is not satisfied and there are many factors to interfere the results.So it is very important to search for a rapid and reliable method for diagnosis of dry eye.With the development of optical coherence tomography(optical coherence tomography,OCT) and further application in anterior segment,the fourth-generation Fourier domain(Fourier domain) OCT has beyond the characteristics of the previous time-domain(Time domain) OCT with high resolution and high speed.It has led to widespread concern researchers with a high-resolution functional imaging of anterior segment of tear meniscus.However, there is no research on the effectiveness of the Fourier-domain OCT in the diagnosis of dry eye and normal tear meniscus area.Therefore,this study will probe on the diagnostic effectiveness and tear meniscus imaging of fourth-generation Fourier domain OCT.We enroll in different ages,different types of dry eye patients,as well as normal controls to explore diagnostic effectiveness of Fourier domain OCT,in order to identify the type of dry eye which has a higher diagnostic effect.At the same time,we make the normal control group into Sub-groups in accordance with age to investigate age-related variations of human tear meniscus in Chinese.The results show that the fourth generation Fourier domain OCT can clearly image and measure the cross-sectional tear meniscus.It also has a good consistency with clinical diagnosis of dry eye examination(BUT,Schirmer test).As a non-invasive,non-contact,simple screening method,the fourth generation Fourier-domain OCT has a good application prospects in the diagnosis of dry eye,especially in aqueous tear deficiency.
PartⅠResearch on the tear meniscus imaging and measurement of the anterior segment Fourier domain OCT
Objective To discuss the utilization of the fourth generation anterior segment Fourier domain optical coherence tomography in the imaging and measurement of tear meniscus
Methods We enrolled 146 cases(146 eyes) and 160 controls(160 eyes) in this study. The tear meniscus height(TMH),tear meniscus depth(TMD) and tear meniscus area (TMA) of each participant were measured by Fourier domain OCT(RTVue-100).We also estimated the tear break up time(BUT),performed the cornea fluorescein staining and Schirmer test,and recorded score of the dry eye questionnaire.The variability of the fourth generation anterior segment Fourier domain OCT in tear meniscus imaging and measurement was discussed.
Results The average values of TMH,TMD and TMA in the patient group were 232.319±17.549(μm)、151.494±12.811(μm)、0.024428±0.003712(mm2), comparing with 328.113±19.036(μm)、220.906±12.935(μm)、0.045618±0.005623(mm2) in the control group,the difference of which reached significant (TMH t=12.2646,P=0.0000,TMD t=12.0567,P=0.0000,TMA t=10.1556, P=0.0000).The individual variability of the TMH,TMD and TMA in the patient group was less than the control group.The repeatability analysis showed a small variation in measurement.The OCT images of the bound and cross section area of the tear meniscus and the clarity of the tear fluid in the patient group were obviously different from those in the control group.
Conclusion The fourth generation Fourier domain anterior segment optical coherence tomography can clearly image and measure the cross section of tear meniscus,the result of which showed a good coherence with the traditional diagnostic test(BUT,Schirmer test) and directly reflect features of the tear meniscus.
PartⅡAge-Related Variations of Human Tear Meniscus in Chinese
Objective To investigate age-related variations of human tear meniscus in Chinese and diagnosis of dry eye using Fourier domain anterior segment OCT.
Methods.We enrolled 146 cases(146 eyes) and 160 controls(160 eyes) in this study.All the subjects in these two groups were divided into four subgroups according to different ages,respectively,group A(0～19),group B(20～39),group C (40～59) and group D(over 60).Dry eye patients have 6,60,60,20 in each group, normal controls have 6,60,60,20 in each group.The tear meniscus height(TMH),tear meniscus depth(TMD) and tear meniscus area(TMA) of each participant were measured by Fourier domain OCT(RTVue-100).We also estimated the tear break up time(BUT),performed the cornea fluorescein staining and Schirmer test,and recorded score of the dry eye questionnaire.The relativity of the clinical examinations was tested,the tear meniscus of the two groups were measured and ROC curves were drawn.
Results There is a significant correlation among tear meniscus values,individual syndrome and clinical diagnoses.The mean TMH、TMD、TMA for dry-eye patients were significantly lower than those for control groups.There was negative correlation between tear meniscus values and age for Chinese healthy subjects(TMH r=-0.0649,p=0.000,TMD r=-0.0299,p=0.0024,TMA r=-0.0320,p=0.0017).The accuracy of the diagnosis of dry eye by Fd-OCT was TMH 68.95%、TMD 70.59%、TMA 70.92%.It's different between the age sub-groups.Area under the ROC curve (AUC) showed that overall,TMH to 0.7337,TMD is 0.7477,TMA is 0.7461.AUC of all ages there are some differences between.TMH Diagnostic value of the overall community for the 259(μm),TMD for 165.6667(μm),TMA was 0.024(mm2),the diagnosis of all ages increase community values decline with age.
Conclusions Fd-OCT could instantly imply the age-related variations of human tear meniscus and has good consistency with the clinical diagnose examinations.It has different diagnostic accuracy in each age sub-group.
PartⅢThe utilization of the fourth generation Fourier domain anterior segment OCT(FD-OCT) in the diagnosis of dry eye
Objective To discuss the utilization of the fourth generation anterior segment Fourier domain OCT in the diagnosis of different types of dry eye patients.
Methods We enrolled 146 cases(146 eyes)of dry eye patients(DE group),102 cases(102 eyes)of aqueous tear deficiency patients(ATD group),81 cases(81 eyes)of lipid tear deficiency patients(LTD group),53 cases(53 eyes)of Sj(o|¨)gren syndrome patients(SS group)and 160 controls(160 eyes) in this study.The tear meniscus height (TMH),tear meniscus depth(TMD) and tear meniscus area(TMA) of each participant were measured by Fourier domain OCT(RTVue-100).We also estimated the tear break up time(BUT),performed the cornea fluorescein staining and Schirmer test,and recorded score of the dry eye questionnaire.The relativity of the clinical examinations was tested,the tear meniscus of the two groups were measured and ROC curves were drawn.
Results The average values of clinical measurements in the patient group were quite different.The results of the diagnostic effectiveness for each group showed,SS group had the highest diagnostic effectiveness,TMH 91.19%,TMD 92.51%,TMA 92.51%; LD group had the lowest,TMH 45.49%,TMD 67.06%,TMA 46.27%.DE group was almost the same with ATD group.The area under the ROC curve(AUC) of TMA showed,DE group was 0.7855,AD group was 0.7110,LD group was 0.5279,SS group was 0.9706.
Conclusion The fourth generation Fourier domain anterior segment optical coherence tomography can accurately measure all types of dry eye tears meniscus,, the result of which showed a good coherence with the traditional diagnostic test(BUT, Schirmer test) and directly reflect features of the tear meniscus.As a non-traumatic and non-contact technique,the fourth generation Fourier domain anterior segment OCT has a favorable prospect in the diagnosis of dry eye,especially in aqueous tear deficiency.
引文
[1].Latkany R.Dry eyes:etiology and management.Curr Opin Ophthalmol.2008;19(4):287-291.
[2].Anonymous.The epidemiology of dry eye disease:report of the Epidemiology Subcommittee of the International Dry Eye Workshop (2007).The Ocular Surface.2007;5(2):93-107
[3].Anonymous.Methodologies to diagnose and monitor dry eye disease:report of the Diagnostic Methodology Subcommittee of the International Dry Eye Workshop (2007).The Ocular Surface.2007;5(2):108-152.
[4].Nichols KK,et al.The repeatability of clinical measurements of dry eye.Cornea.2004;23:272-285.
[5].Mishima S,Gasset A,KlyceSD Jr,Baum JL.Determination of tear volume and tear flow.Invest Ophthalmol 1966;5:264-76.
[6].Holly FJ.Physical chemistry of the normal and disordered tear film.Trans Ophthalmol Soc U K 1985;104:374-80.
[7].Mainstone JC,Bruce AS,Golding TR.Tear meniscus measurement in the diagnosis of dry eye.Curr Eye Res 1996;15:653-61.
[8].Halit O,et al.The Height and Radius of the Tear Meniscus and Methods for Examining These Parameters.Cornea 2000,19(4):497-500.
[9].Giacomo S,et al.Tear Meniscus Evaluation by Optical Coherence Tomography.Ophthalmic Surgery,Lasers and Imaging,2006;37(2):112-119.
[10].Jones L,et al.A Novel Method to determine TMH.Centre for Contact Lens Research,School of optometry,University of Waterloo,Ontario,Canada.
[11].Jianhua W,et al.Repeated Measurements of Dynamic Tear Distribution on the Ocular Surface after Instillation of Artificial Tears.Invest Ophthalmol Vis Sci.2006;47:3325-3329
[12].Jianhua Wang,Jayachandra R,James V.Correlations Among Upper and Lower Tear Menisci,Noninvasive Tear Break-up Time,and the Schirmer Test.Am J Ophthalmol.2008;145:795-800.
[13].Jianhua W,et al.Precomeal and Pre-and Postlens Tear Film Thickness Measured Indirectly with Optical Coherence Tomography.Invest Ophthalmol Vis Sci.2003;44:2524-2528.
[14].吕帆,瞿佳.干眼的临床诊断研究.中国实用眼科杂志,2007,20:514-517.
[15].Huang D,et al.Optical coherence tomography.Science 1991.254:1178-1181.
[16].Takada K,et al.New measurement system for fault location in optical waveguide devices based on an interferometric technique.Appl Opt 1987.26:1603.
[17].Izatt JA,et al.Micrometer-scale resolution imaging of the anterior eye in vivo with optical coherence tomography.Arch Ophthalmol 1994.12:1584.
[18].Hoerauf H,et al.First experimental and clinical results with transscleral optical coherence tomography.Ophthalmic Surg Las Imag,2000;31(3):218-222.
[19].Hoerauf H,et al.Transseleral optical coherence tomography:a new imaging method for the anterior segment of the eye,Arch Ophthalmol,2002;120(6):816-819.
[20].Hoerauf H,et al.Transscleral optical coherence tomography-an experimental study in ex-vivo human eyes.Lasers Surg Med.2002;30(3):209-215.
[21].Radhakrishnan S,et al.Comparison of optical coherence tomography and ultrasound biomicroscopy for detection of narrow anterior chamber angles Arch Ophthalmol,2005,123:1053-1059.
[22].Radhakrishnan S,Rollins AM,Roth JE,et al.Real-time optical coherence tomography of the anterior segment at 1310 nm.Arch Ophthalmol,2001,119:1179-1185.
[23].Tomlins P H,Wang R K.Theory,developments and applications of optical coherence tomography.Appl Phys,2005,8:2519-2535.
[24].Holly FJ.Physical chemistry of the normal and disordered tear film.Trans Ophthalmol Soc U K 1985;104:374-380.
[25].Micheal EJ,et al.The Agreement and Repeatability of Tear Meniscus Height Measurement Methods.Optom Vis Sci 2005;82:1030-1037
[26].Meixiao Shen,Jianhua Wang,Aizhu Tao,et al.Diurnal variation of upper and lower tear menisci.Am J Ophthalmol 2008;145:801-806.
[27].Jianhua Wang,Jayachandra R,James V.Correlations Among Upper and Lower Tear Menisci,Noninvasive Tear Break-up Time,and the Schirmer Test.Am J Ophthalmol.2008;145:795-800.
[28].Bitton E,Keech A,Simpson T,et al.Variability of the analysis of the tear meniscus height by optical coherence tomography.Optom Vis Sci.2007;84(9):903-908.
[29].Lamberts DW,Foster CS,Perry HD.Schirmer test after topical anesthesia and the tear meniscus height in normal eyes.Arch Ophthalmol 1979;97:1082-1085.
[30].Burkat CN,Lucarelli MJ.Tear meniscus level as an indicator of nasolacrimal obstruction.Ophthalmology 2005;112:344-348.
[31].Doughty MJ,Laiquzzaman M,Button NF.Video-assessment of tear meniscus height in elderly Caucasians and its relationship to the exposed ocular surface.Curr Eye Res 2001;22:420-426.
[32].Begley CG,Himebaugh N,Renner D,et al.Tear break-up dynamics:a technique for quantifying tear film instability.Optom Vis Sci 2006;83:15-21.
[33].Murube J.The Schirmer testxelebration of its first centenary.The Ocular Surface.2003;4:157-159.
[34].Sangwan VS,Tseng SCG New perspectives in ocular surface disorders:an integrated approach for diagnosis and management.Indian J Ophthalmol.2001;49:153-168.
[35].Mengher LS,Bron AJ,Tonge SR,et al.Effect of fluorescein instillation on the pre-corneal tear film stability.Curr Eye Res 1985;4:9-12.
[36].Patel S,Murray D,McKenzie A,et al.Effects of fluorescein on tear break-up time and on tear thinning time.Am J Optom Physiol Opt 1985;62:188-190.
[37].Khurana AK,Chaudhary R,Ahluwalia BK,et al.Tear film profile in dry eye.Acta Ophthalmol (Copenh) 1991;69:79-86
[38].Henderson JW,Prough WA.Influence of age and sex on flow of tears.Arch Ophthalmol 1950;43:224-231.
[39].Wright JC,Meger GE.A review of the Schirmer test for tear production.Arch Ophthalmol 1962;67:564-565.
[40].Mathers WD,Lane JA,Zimmerman MB.Tear film changes associated with normal aging.Cornea 1996;15:229-234.
[41].Patel S,Farrell JC.Age-related changes in precorneal tear film stability.Optom Vis Sci 1989;66:175-178.
[42].Wang HF,Fukuda M,Shimomura Y.Diagnosis of dry eye.Semin Ophthalmol 2005;20:53-62.
[43].Elson JD.Aclinician looks at the tear film.Adv Exp Med Biol.1998;438:1-11.
[44].Lemp MA.Dry eye (Keratoconjunctivitis Sicca),rheumatoid arthritis,and Sjogren's syndrome.Am J Ophthalmol.2005;140(5):898-899.
[45].Driver PJ,Lemp MA.Meibomian gland dysfunction.Surv Ophthalmol.1996;40(5):343-67.
[46].Lemp MA.The 1998 Castroviejo Lecture.New strategies in the treatment of dry-eye states.Cornea.1999;18(6):625-632.
[47].Hanley JA.Receiver operating characteristic (ROC) methodology:the state of the art.Crit Rev Diagn Imaging.1989;29(3):307-35.
[48].Song HH.Analysis of correlated ROC areas in diagnostic testing.Biometrics.1997;53(1):370-382.
[1]、Huang D,et al.Optical coherence tomography.Science 1991.254:1178-1181.
[2]、Izatt JA,et al.Micrometer-scale resolution imaging of the anterior eye in vivo with optical coherence tomography.Arch Ophthalmol 1994.12:1584.
[3]、Hoerauf H,et al.First experimental and clinical results with transscleral optical coherence tomography.Ophthalmic Surg Lasers,2000;31(3):218-222
[4]、Tomlins P H,Wang R K.Theory,developments and applications of optical coherence tomography[J].Appl Phys,2005,8:2519-2535.
[5]、Gary R,et al.Assessment of central corneal thickness using optical coherence tomography.J Cataract Refract Surg 2005;31:707-711
[6]、Ustundag C,et al.Optical cohenrence tomography for evaluation of anatomical changes in the cornea after laser in situ keratomileusis.J Cataract Refract Surg,2000,26:1458-1462.
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[19]、 Halit O,et al.The Height and Radius of the Tear Meniscus and Methods for Examining These Parameters.Cornea 2000,19(4):497-500.
[20]、 Micheal EJ,et al.The Agreement and Repeatability of Tear Meniscus Height Measurement Methods.Optom Vis Sci 2005;82:1030-1037.
[21]、 Meixiao Shen,Jianhua Wang,Aizhu Tao,et al.Diurnal variation of upper and lower tear menisci.Am J Ophthalmol 2008;145:801-806 Jones L,et al.
[22]、 Jianhua W,et al.Repeated Measurements of Dynamic Tear Distribution on the Ocular Surface after Instillation of Artificial Tears.Invest Ophthalmol Vis Sci.2006;47:3325-3329
[23]、 Jianhua Wang,Jayachandra R,James V.Correlations Among Upper and Lower Tear Menisci,Noninvasive Tear Break-up Time,and the Schirmer Test.Am J Ophthalmol.2008;145:795-800.
[24]、 Jianhua W,et al.Precorneal and Pre-and Postlens Tear Film Thickness Measured Indirectly with Optical Coherence Tomography Invest Ophthalmol Vis Sci.2003;44:2524-2528.
[25]、 Huang D,Li Y,Radhakrishnan S,et al.Optical coherence tomography of the anterior segment of the eye.Ophthalmol Clin North Am,2004,17:1-6.
[26]、 Bechmann M,et al.Central corneal thickness measurement with a retinal optical coherence tomography device versus standard ultrasonic pachymetry.Cornea,2001,20(1):50—54.
[27]、 Singh P,Chew D,Friedman W,et al.Imaging of trabeculectomy blebs using anterior segment optical coherence tomography.Ophthalmology,2007,114(1):47-53.
[28]、 Leung CK,Yick DW,Kwong YY,et al.Analysis of bleb morphology after trabeculectomy with Visante anterior segment optical coherence tomography.Br J Ophthalmol,2007,91:340-344.
[29]、 Calladine D,Packard R.Clear corneal incision architecture in the immediate postoperative period evaluated using optical coherence tomography.J Cata Ref Surg,2007,33 (8):1429-1435.
[30]、BuchwaldHJ,et al.Optical coherence tomography versus ultrasound biomicroscopy of conjunctival and eyelid lesions.Kiln Monatsbl Augenheilkd,2003;220(12):822-829.
[2].Anonymous.The epidemiology of dry eye disease:report of the Epidemiology Subcommittee of the International Dry Eye Workshop (2007).The Ocular Surface.2007;5(2):93-107
[3].Anonymous.Methodologies to diagnose and monitor dry eye disease:report of the Diagnostic Methodology Subcommittee of the International Dry Eye Workshop (2007).The Ocular Surface.2007;5(2):108-152.
[4].Nichols KK,et al.The repeatability of clinical measurements of dry eye.Cornea.2004;23:272-285.
[5].Mishima S,Gasset A,KlyceSD Jr,Baum JL.Determination of tear volume and tear flow.Invest Ophthalmol 1966;5:264-76.
[6].Holly FJ.Physical chemistry of the normal and disordered tear film.Trans Ophthalmol Soc U K 1985;104:374-80.
[7].Mainstone JC,Bruce AS,Golding TR.Tear meniscus measurement in the diagnosis of dry eye.Curr Eye Res 1996;15:653-61.
[8].Halit O,et al.The Height and Radius of the Tear Meniscus and Methods for Examining These Parameters.Cornea 2000,19(4):497-500.
[9].Giacomo S,et al.Tear Meniscus Evaluation by Optical Coherence Tomography.Ophthalmic Surgery,Lasers and Imaging,2006;37(2):112-119.
[10].Jones L,et al.A Novel Method to determine TMH.Centre for Contact Lens Research,School of optometry,University of Waterloo,Ontario,Canada.
[11].Jianhua W,et al.Repeated Measurements of Dynamic Tear Distribution on the Ocular Surface after Instillation of Artificial Tears.Invest Ophthalmol Vis Sci.2006;47:3325-3329
[12].Jianhua Wang,Jayachandra R,James V.Correlations Among Upper and Lower Tear Menisci,Noninvasive Tear Break-up Time,and the Schirmer Test.Am J Ophthalmol.2008;145:795-800.
[13].Jianhua W,et al.Precomeal and Pre-and Postlens Tear Film Thickness Measured Indirectly with Optical Coherence Tomography.Invest Ophthalmol Vis Sci.2003;44:2524-2528.
[14].吕帆,瞿佳.干眼的临床诊断研究.中国实用眼科杂志,2007,20:514-517.
[15].Huang D,et al.Optical coherence tomography.Science 1991.254:1178-1181.
[16].Takada K,et al.New measurement system for fault location in optical waveguide devices based on an interferometric technique.Appl Opt 1987.26:1603.
[17].Izatt JA,et al.Micrometer-scale resolution imaging of the anterior eye in vivo with optical coherence tomography.Arch Ophthalmol 1994.12:1584.
[18].Hoerauf H,et al.First experimental and clinical results with transscleral optical coherence tomography.Ophthalmic Surg Las Imag,2000;31(3):218-222.
[19].Hoerauf H,et al.Transseleral optical coherence tomography:a new imaging method for the anterior segment of the eye,Arch Ophthalmol,2002;120(6):816-819.
[20].Hoerauf H,et al.Transscleral optical coherence tomography-an experimental study in ex-vivo human eyes.Lasers Surg Med.2002;30(3):209-215.
[21].Radhakrishnan S,et al.Comparison of optical coherence tomography and ultrasound biomicroscopy for detection of narrow anterior chamber angles Arch Ophthalmol,2005,123:1053-1059.
[22].Radhakrishnan S,Rollins AM,Roth JE,et al.Real-time optical coherence tomography of the anterior segment at 1310 nm.Arch Ophthalmol,2001,119:1179-1185.
[23].Tomlins P H,Wang R K.Theory,developments and applications of optical coherence tomography.Appl Phys,2005,8:2519-2535.
[24].Holly FJ.Physical chemistry of the normal and disordered tear film.Trans Ophthalmol Soc U K 1985;104:374-380.
[25].Micheal EJ,et al.The Agreement and Repeatability of Tear Meniscus Height Measurement Methods.Optom Vis Sci 2005;82:1030-1037
[26].Meixiao Shen,Jianhua Wang,Aizhu Tao,et al.Diurnal variation of upper and lower tear menisci.Am J Ophthalmol 2008;145:801-806.
[27].Jianhua Wang,Jayachandra R,James V.Correlations Among Upper and Lower Tear Menisci,Noninvasive Tear Break-up Time,and the Schirmer Test.Am J Ophthalmol.2008;145:795-800.
[28].Bitton E,Keech A,Simpson T,et al.Variability of the analysis of the tear meniscus height by optical coherence tomography.Optom Vis Sci.2007;84(9):903-908.
[29].Lamberts DW,Foster CS,Perry HD.Schirmer test after topical anesthesia and the tear meniscus height in normal eyes.Arch Ophthalmol 1979;97:1082-1085.
[30].Burkat CN,Lucarelli MJ.Tear meniscus level as an indicator of nasolacrimal obstruction.Ophthalmology 2005;112:344-348.
[31].Doughty MJ,Laiquzzaman M,Button NF.Video-assessment of tear meniscus height in elderly Caucasians and its relationship to the exposed ocular surface.Curr Eye Res 2001;22:420-426.
[32].Begley CG,Himebaugh N,Renner D,et al.Tear break-up dynamics:a technique for quantifying tear film instability.Optom Vis Sci 2006;83:15-21.
[33].Murube J.The Schirmer testxelebration of its first centenary.The Ocular Surface.2003;4:157-159.
[34].Sangwan VS,Tseng SCG New perspectives in ocular surface disorders:an integrated approach for diagnosis and management.Indian J Ophthalmol.2001;49:153-168.
[35].Mengher LS,Bron AJ,Tonge SR,et al.Effect of fluorescein instillation on the pre-corneal tear film stability.Curr Eye Res 1985;4:9-12.
[36].Patel S,Murray D,McKenzie A,et al.Effects of fluorescein on tear break-up time and on tear thinning time.Am J Optom Physiol Opt 1985;62:188-190.
[37].Khurana AK,Chaudhary R,Ahluwalia BK,et al.Tear film profile in dry eye.Acta Ophthalmol (Copenh) 1991;69:79-86
[38].Henderson JW,Prough WA.Influence of age and sex on flow of tears.Arch Ophthalmol 1950;43:224-231.
[39].Wright JC,Meger GE.A review of the Schirmer test for tear production.Arch Ophthalmol 1962;67:564-565.
[40].Mathers WD,Lane JA,Zimmerman MB.Tear film changes associated with normal aging.Cornea 1996;15:229-234.
[41].Patel S,Farrell JC.Age-related changes in precorneal tear film stability.Optom Vis Sci 1989;66:175-178.
[42].Wang HF,Fukuda M,Shimomura Y.Diagnosis of dry eye.Semin Ophthalmol 2005;20:53-62.
[43].Elson JD.Aclinician looks at the tear film.Adv Exp Med Biol.1998;438:1-11.
[44].Lemp MA.Dry eye (Keratoconjunctivitis Sicca),rheumatoid arthritis,and Sjogren's syndrome.Am J Ophthalmol.2005;140(5):898-899.
[45].Driver PJ,Lemp MA.Meibomian gland dysfunction.Surv Ophthalmol.1996;40(5):343-67.
[46].Lemp MA.The 1998 Castroviejo Lecture.New strategies in the treatment of dry-eye states.Cornea.1999;18(6):625-632.
[47].Hanley JA.Receiver operating characteristic (ROC) methodology:the state of the art.Crit Rev Diagn Imaging.1989;29(3):307-35.
[48].Song HH.Analysis of correlated ROC areas in diagnostic testing.Biometrics.1997;53(1):370-382.
[1]、Huang D,et al.Optical coherence tomography.Science 1991.254:1178-1181.
[2]、Izatt JA,et al.Micrometer-scale resolution imaging of the anterior eye in vivo with optical coherence tomography.Arch Ophthalmol 1994.12:1584.
[3]、Hoerauf H,et al.First experimental and clinical results with transscleral optical coherence tomography.Ophthalmic Surg Lasers,2000;31(3):218-222
[4]、Tomlins P H,Wang R K.Theory,developments and applications of optical coherence tomography[J].Appl Phys,2005,8:2519-2535.
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