Suphakasem Surawoot, Lekskul Manapon, Rangsin Ram
Department of Ophthalmology, Phramongkutklao Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2012 May;95 Suppl 5:S107-10.
To evaluate the correlation between different wetting time and paper strip size of Schirmer test with anesthesia in dry eye patient. Finally the authors determined the agreement on using the ocular surface disease index (OSDI), index for evaluate the severity of the dry eye patient, compare to the standard Schirmer test with anesthesia.
A prospective study was performed in 140 eyes of 70 subjects. All subjects had symptoms of dry eye syndrome which was confirmed by Schirmer test with anesthesia before inclusion. The correlation between Schirmer test with anesthesia at 1, 2, 3 and 4 minutes and standard 5-minute test of both 3 mm and 5 mm width of paper strip was evaluated using intraclass correlation coefficient (ICC). The correlation between clinical questions and Schirmer test was documented in Kappa value.
The ICCs were higher than 0.8 after 2 minutes in both 3-mm and 5-mm width of paper strip. Furthermore, it indicated that cut-off value for diagnosis of severe dry eye was 2.5 mm for 5-mm width of paper strip and 4.25 mm for 3-mm width of paper strip at 2-minute measurement. The association between data from the OSDI and objective data from Schirmer test were analyzed by Kappa statistic and showed poor agreement beyond chance (p = 0.591).
Our results suggested that shorter wetting time of 2-minute Schirmer test with anesthesia could be used instead of the standard 5-minute test. The authors found that the 3-mm width of paper strip could be used instead of the standard 5-mm width of paper strip as well.
评估干眼症患者在表面麻醉下施密特试验不同湿润时间与试纸条尺寸之间的相关性。最后，作者确定了使用眼表疾病指数（OSDI）（用于评估干眼症患者严重程度的指标）与标准表面麻醉下施密特试验结果之间的一致性。
对70名受试者的140只眼睛进行了一项前瞻性研究。所有受试者均有干眼症综合征症状，在纳入研究前通过表面麻醉下施密特试验得以证实。使用组内相关系数（ICC）评估表面麻醉下施密特试验在1、2、3和4分钟时与标准5分钟试验中3毫米和5毫米宽试纸条的相关性。临床问题与施密特试验之间的相关性以Kappa值记录。
在3毫米和5毫米宽的试纸条中，2分钟后ICC均高于0.8。此外，结果表明，在2分钟测量时，5毫米宽试纸条诊断重度干眼症的临界值为2.5毫米，3毫米宽试纸条为4.25毫米。通过Kappa统计分析OSDI数据与施密特试验客观数据之间的关联，结果显示一致性较差，无显著相关性（p = 0.591）。
我们的结果表明，表面麻醉下施密特试验2分钟的较短湿润时间可替代标准的5分钟试验。作者还发现，3毫米宽的试纸条也可替代标准的5毫米宽试纸条。
