Evaluation of tear meniscus height using different clinical methods


Clinical relevance: The height of the tear meniscus (TMH) is a generally accepted method to evaluate tear film volume, especially in dry eye diagnoses and management.Background: The purpose of this study was to evaluate the ability of different methods to measure tear meniscus height accurately and repeatably.Methods: Lower TMH of 20 volunteers (26.8 ± 5.6 years) was measured by two observers (OI and OII) using optical coherence tomography (OCT), slitlamp microscope image analysis, and with a reticule at low (8x) and high (32x) magnification. TMH was also evaluated by both observers by comparing TMH to thickness of the lid margin (lid-ratio; grade 0: TMH 1/2 lid margin thickness; grade 1: 1/3; grade 2: 1/4; grade 3: 1/5; grade 4: 1/6) and to the number of eyelashes fitting in the tear meniscus. Differences between observers were analysed by paired-t-test. Differences between OCT-TMH and other methods were analysed by ANOVA, and inter-observer repeatability by intra-class-correlation-coefficient (ICC). The ability to predict OCT-TMH was calculated by receiver operative characteristic (ROC) curve analysis.Results: There was no significant difference between OI and OII in all methods except of the eyelash-count-method (p = 0.008). For OI, TMH measured using a reticule at 8x (0.20 ± 0.05 mm) was significantly lower than OCT-TMH (0.24 ± 0.07 mm) (p = 0.032) but not at 32x (0.22 ± 0.01 mm; p = 0.435). TMH evaluated by the image software of the slitlamp (0.20 ± 0.05 mm) was significantly lower than OCT-TMH (p = 0.022). The lid-ratio-method and eyelash-count-method resulted in grades of 2.35 ± 1.22 and 2.85 ± 0.81, respectively. ROC analyses showed that only the 8x and the 32x magnification method could discriminate between normal and abnormal OCT-TMH. OCT had the best repeatability (ICC = 0.88; p < 0.001) followed by reticule using 32x magnification (ICC = 0.70; p = 0.004).Conclusion: The most reliable method to measure TMH was OCT followed by slitlamp using a reticule. TMH cannot be reliably evaluated by comparing it against lid margin thickness or number of eyelashes.

Publication DOI: https://doi.org/10.1080/08164622.2021.1878854
Divisions: College of Health & Life Sciences > School of Optometry > Optometry
College of Health & Life Sciences > School of Optometry > Optometry & Vision Science Research Group (OVSRG)
College of Health & Life Sciences
Additional Information: This is an Accepted Manuscript version of the following article, accepted for publication in Clinical and Experimental Optometry. Britta Niedernolte, Lisa Trunk, James S Wolffsohn, Heiko Pult & Stefan Bandlitz (2021) Evaluation of tear meniscus height using different clinical methods, Clinical and Experimental Optometry, 104:5, 583-588. It is deposited under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Uncontrolled Keywords: Dry eye diagnosis,eye lashes,lid thickness,optical coherence tomography,tear film volume,tear meniscus height,Ophthalmology,Optometry
Publication ISSN: 1444-0938
Last Modified: 14 May 2024 07:22
Date Deposited: 12 Jul 2021 10:35
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Related URLs: https://www.tan ... rnalCode=tceo20 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2021-09-01
Published Online Date: 2021-03-02
Accepted Date: 2020-10-30
Authors: Niedernolte, Britta
Trunk, Lisa
Wolffsohn, James S (ORCID Profile 0000-0003-4673-8927)
Pult, Heiko
Bandlitz, Stefan


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