Wang Michael T M, Power Barry, Xue Ally L, Craig Jennifer P
Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, New Zealand.
Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, New Zealand; Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
Ocul Surf. 2024 Oct;34:165-172. doi: 10.1016/j.jtos.2024.07.004. Epub 2024 Jul 20.
To evaluate the diagnostic performance of corneal and conjunctival staining, and lid wiper epitheliopathy (LWE) in detecting dry eye disease, as defined by the global consensus Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) criteria.
A total of 2066 community residents (1285 females; mean ± SD age, 40 ± 19 years) were recruited in an investigator-masked, prospective registry-based, diagnostic accuracy study. Dry eye symptomology and ocular surface parameters were assessed in a single clinical session. The Sjögren's International Collaborative Clinical Alliance (SICCA) corneal and conjunctival staining scoring and Korb lid wiper epitheliopathy (LWE) grading were evaluated by an independent masked assessor.
Overall, 807 (39 %) participants fulfilled the TFOS DEWS II criteria for dry eye disease, of which 178 (9 %) participants were classified as moderate-to-severe disease. The discriminative abilities of superior and inferior LWE (C-statistics, 0.724 and 0.712, respectively) were greater than corneal and conjunctival staining (C-statistics, 0.573 and 0.627, respectively). The Youden-optimal diagnostic cut-offs for the SICCA corneal and conjunctival staining scores were both ≥1, and the optimal thresholds for the Korb superior and inferior LWE grades were both ≥1. LWE was more commonly detected in both mild-to-moderate and moderate-to-severe dry eye disease, and demonstrated more consistent correlation with other ocular surface parameters across a broader range of disease severity.
LWE demonstrates superior diagnostic performance relative to corneal and conjunctival staining. These findings would support the routine incorporation of LWE evaluation as part of the diagnostic workup of dry eye disease.
根据全球泪膜与眼表协会干眼研讨会II（TFOS DEWS II）标准定义，评估角膜和结膜染色以及睑板腺上皮病变（LWE）在检测干眼病中的诊断性能。
在一项研究者设盲、基于前瞻性登记的诊断准确性研究中，招募了总共2066名社区居民（1285名女性；平均±标准差年龄，40±19岁）。在单次临床检查中评估干眼症状和眼表参数。由独立的设盲评估者评估干燥综合征国际协作临床联盟（SICCA）角膜和结膜染色评分以及科尔布睑板腺上皮病变（LWE）分级。
总体而言，807名（39%）参与者符合TFOS DEWS II干眼病标准，其中178名（9%）参与者被归类为中重度疾病。上睑和下睑LWE的鉴别能力（C统计量分别为0.724和0.712）大于角膜和结膜染色（C统计量分别为0.573和0.627）。SICCA角膜和结膜染色评分的约登最佳诊断临界值均≥1，科尔布上睑和下睑LWE分级的最佳阈值均≥1。LWE在轻度至中度和中度至重度干眼病中更常被检测到，并且在更广泛的疾病严重程度范围内与其他眼表参数表现出更一致的相关性。
LWE相对于角膜和结膜染色表现出更好的诊断性能。这些发现将支持将LWE评估作为干眼病诊断检查的一部分常规纳入。
