De La Parra-Colin Paola, Palacios-Aguirre Karen, Perez-Pria-Kasusky Andrea, Espinosa-Morales Rolando, Hidalgo-Bravo Alberto
Cornea and Ocular Surface Clinic, Department of Ophthalmology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ministry of Health, Mexico City 14389, Mexico.
Department of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ministry of Health, Mexico City 14389, Mexico.
Diagnostics (Basel). 2023 Sep 19;13(18):2994. doi: 10.3390/diagnostics13182994.
The aim of our study was to evaluate the diagnostic capacity of the tear meniscus osmolarity measurement for dry eye disease (DED) in patients with rheumatoid arthritis (RA), using a portable osmometer based on electrical impedance and an integrated circuit technology (TearLab (Escondido, CA, USA)).
We included 101 RA patients, 81 patients with DED and 20 without DED (controls). We measured tear osmolarity and assessed other clinical diagnostic tests as suggested by the TFOS DEWS II composite reference standard diagnostic criteria for DED using Ocular Surface Disease Index (OSDI), Five-item Dry Eye Questionnaire (DEQ-5), fluorescein tear break-up time (F-TUBT), ocular surface staining (SICCA score), and other clinical parameters to classify DED subtypes. We analyzed the agreement between osmolarity and the TFOS DEWS II composite reference standard for DED diagnosis. We conducted receiver operating characteristic (ROC) curve analyses using the DED variable and its subtypes as dependent variables and the continuous variable for osmolarity or the inter-eye difference in osmolarity as independent variable. Sensitivity, specificity, and area under the curve for all potential cut-off points were obtained and reported from ROC curves.
We found that tear meniscus osmolarity had a low diagnostic capacity for DED (AUC = 0.57). Tear meniscus osmolarity measurement had a sensitivity of 35% and a specificity of 80% with a kappa level of agreement of 0.08 compared to the TFOS DEWS II composite reference standard. The low diagnostic capacity of the tear meniscus osmolarity was similar for aqueous-deficient DED and for evaporative DED, being only fair for severe DED with a 57% sensitivity and 80% specificity and a kappa level of agreement of 0.36.
Our findings suggest that in patients with RA, tear meniscus osmolarity measured by the TearLab showed low sensitivity, low specificity, and limited agreement with the TFOS DEWS II composite reference standard for DED diagnosis.
我们研究的目的是使用基于电阻抗和集成电路技术的便携式渗透压计（美国加利福尼亚州埃斯孔迪多市的TearLab），评估泪液半月板渗透压测量对类风湿性关节炎（RA）患者干眼症（DED）的诊断能力。
我们纳入了101例RA患者，81例DED患者和20例无DED的患者（对照组）。我们测量了泪液渗透压，并根据TFOS DEWS II综合参考标准诊断标准，使用眼表疾病指数（OSDI）、五项干眼问卷（DEQ-5）、荧光素泪膜破裂时间（F-TUBT）、眼表染色（SICCA评分）和其他临床参数评估了其他临床诊断测试，以对DED亚型进行分类。我们分析了渗透压与TFOS DEWS II综合参考标准在DED诊断方面的一致性。我们使用DED变量及其亚型作为因变量，以渗透压的连续变量或两眼间渗透压差异作为自变量，进行了受试者操作特征（ROC）曲线分析。从ROC曲线中获得并报告了所有潜在切点的敏感性、特异性和曲线下面积。
我们发现泪液半月板渗透压对DED的诊断能力较低（AUC = 0.57）。与TFOS DEWS II综合参考标准相比，泪液半月板渗透压测量的敏感性为35%，特异性为80%，kappa一致性水平为0.08。泪液半月板渗透压的低诊断能力在水液缺乏性DED和蒸发过强性DED中相似，对于重度DED仅为一般，敏感性为57%，特异性为80%，kappa一致性水平为0.36。
我们的研究结果表明，在RA患者中，TearLab测量的泪液半月板渗透压显示出低敏感性、低特异性，并且与TFOS DEWS II综合参考标准在DED诊断方面的一致性有限。
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