用于干眼综合征自我诊断的评估泪膜稳定性的简单有效测试：眨眼耐受时间（BTT）。
Easy and effective test to evaluate tear-film stability for self-diagnosis of dry eye syndrome: blinking tolerance time (BTT).
作者信息
Hwang Hyung Bin, Ku Yong Ho, Kim Eun Chul, Kim Hyun Seung, Kim Man Soo, Hwang Ho Sik
机构信息
Department of Ophthalmology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
Department of Ophthalmology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Republic of Korea.
出版信息
BMC Ophthalmol. 2020 Nov 4;20(1):438. doi: 10.1186/s12886-020-01686-5.
BACKGROUND
The tear film breakup time (tBUT) is a clinical evaluation of evaporative dry eye disease assessed by instilling topical fluorescein into the eyes. In the present study, we introduce a new diagnostic test, blinking tolerance time (BTT), for self-evaluation of tear-film stability. We compared the results with the tBUT and validated the BTT test for self-assessment of tear film instability.
METHODS
This was a prospective controlled study involving 212 eyes of 106 participants 20-79 years of age. A total of 114 eyes of 57 dry eye patients and 98 eyes of 49 healthy subjects were included in the study. All patients and subjects were administered the following tests to diagnose dry eye disease: Ocular Surface Disease Index, BTT, tBUT, slit-lamp examination, corneal stain score, and Schirmer I test (without anesthesia). Patients and subjects were instructed not to blink for as long possible after reset blinking. The time interval between the reset blink and the next blink was measured. The mean of 3 tBUT values in both the right and left eyes was defined as tBUT. Correlations between the BTT and tBUT were also evaluated. To evaluate the diagnostic efficacy of the BTT and tBUT tests, receiver operating characteristic (ROC) curves were generated to obtain a cutoff score, and the sensitivities of the tests against the specificity at all possible thresholds were plotted.
RESULTS
Spearman's correlation analysis revealed a significant weakly positive correlation between BTT and tBUT (r = 0.447; p = 0.000). The intraclass correlation coefficient (ICC) of the tBUT was 0.679 (95% confidence interval [CI]: 0.575-0.765) and the ICC of the BTT was 0.904 (95% CI: 0.867-0.932). The area under the ROC curve did not significantly differ between the tBUT (0.678) and BTT (0.628, p = 0.641). When the cutoff value of the BTT test was set to 8.1 s, the sensitivity was 63.3% and the specificity was 56.1%.
CONCLUSION
The BTT test is a simple, inexpensive, and effective method for self-diagnosing dry eye that can also be used in the clinical setting.
背景
泪膜破裂时间（tBUT）是通过向眼睛滴入局部荧光素来评估蒸发型干眼疾病的一项临床指标。在本研究中，我们引入了一种新的诊断测试——眨眼耐受时间（BTT），用于自我评估泪膜稳定性。我们将结果与tBUT进行比较，并验证了BTT测试用于泪膜不稳定自我评估的有效性。
方法
这是一项前瞻性对照研究，涉及106名年龄在20 - 79岁之间参与者的212只眼睛。研究共纳入57名干眼患者的114只眼睛和49名健康受试者的98只眼睛。所有患者和受试者均接受以下测试以诊断干眼疾病：眼表疾病指数、BTT、tBUT、裂隙灯检查、角膜染色评分和Schirmer I试验（无麻醉）。指导患者和受试者在重新眨眼后尽可能长时间不眨眼。测量重新眨眼与下一次眨眼之间的时间间隔。将左右眼3个tBUT值的平均值定义为tBUT。还评估了BTT与tBUT之间的相关性。为评估BTT和tBUT测试的诊断效能，绘制受试者工作特征（ROC）曲线以获得临界值，并绘制所有可能阈值下测试的敏感性与特异性。
结果
Spearman相关性分析显示BTT与tBUT之间存在显著的弱正相关（r = 0.447；p = 0.000）。tBUT的组内相关系数（ICC）为0.679（95%置信区间[CI]：0.575 - 0.765），BTT的ICC为0.904（95%CI：0.867 - 0.932）。tBUT（0.678）和BTT（0.628，p = 0.641）的ROC曲线下面积无显著差异。当将BTT测试的临界值设定为8.1秒时，敏感性为63.3%，特异性为56.1%。
结论
BTT测试是一种简单、廉价且有效的自我诊断干眼的方法，也可用于临床环境。
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