Wang Michael T M, Power Barry, Xue Ally L, Kim Ji Soo, Craig Jennifer P
Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.
Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
Cont Lens Anterior Eye. 2025 Apr;48(2):102324. doi: 10.1016/j.clae.2024.102324. Epub 2024 Nov 17.
To evaluate the discriminative abilities and optimal cut-off values of qualitative meiboscale grading and percentage meibomian gland dropout measurements from each of two instruments (Keratograph 5M and LipiView II) in detecting dry eye disease, as defined by the TFOS DEWS II criteria.
A total of 227 community residents (143 females, 84 males; mean ± SD age, 36 ± 15 years) were recruited in a prospective, investigator-masked, randomised, crossover study. Dry eye symptomology, tear film parameters, and ocular surface characteristics were evaluated in a single clinical session. Qualitative meiboscale grading and quantitative percentage gland dropout assessment using Image J software were evaluated by independent masked assessors, in a randomised order.
Overall, 92 (41 %) participants fulfilled the TFOS DEWS II criteria for dry eye disease. The diagnostic performances for percentage meibomian gland dropout measurements (C-statistic range, 0.629 to 0.647) were significantly greater than qualitative meiboscale grading (C-statistic range, 0.547 to 0.560) for both instruments. The Youden-optimal diagnostic cut-off percentage gland dropout was > 20 % and optimal threshold meiboscale grade was > 1 for both superior and inferior eyelid measurements from the two instruments. Inter-instrument weighted Cohen's kappa coefficients for meiboscale grading were 0.734 and 0.682, respectively, and Bland-Altman biases (95 % limits of agreement) for percentage gland dropout were -1.8 % (-28.1 % to 24.4 %) and -1.5 % (-29.3 % to 26.2 %), respectively.
Despite exhibiting comparable discriminative abilities, meibography parameters obtained from the Keratograph and LipiView were not directly interchangeable. Overall, percentage gland dropout measurements demonstrated superior diagnostic performance, which would support their use in clinical trials and epidemiology studies, where practicable.
根据TFOS DEWS II标准，评估两种仪器（角膜地形图仪5M和LipiView II）各自的睑板腺定性分级和睑板腺缺失百分比测量值在检测干眼病方面的鉴别能力和最佳临界值。
在一项前瞻性、研究者设盲、随机、交叉研究中，共招募了227名社区居民（143名女性，84名男性；平均±标准差年龄，36±15岁）。在单次临床检查中评估干眼症状、泪膜参数和眼表特征。由独立的设盲评估者以随机顺序评估使用Image J软件进行的睑板腺定性分级和定量腺缺失百分比评估。
总体而言，92名（41%）参与者符合TFOS DEWS II干眼病标准。两种仪器的睑板腺缺失百分比测量值的诊断性能（C统计量范围，0.629至0.647）显著高于睑板腺定性分级（C统计量范围，0.547至0.560）。两种仪器上下眼睑测量的尤登最佳诊断临界腺缺失百分比均>20%，最佳睑板腺分级阈值均>1。睑板腺分级的仪器间加权科恩kappa系数分别为0.734和0.682，腺缺失百分比的布兰德-奥特曼偏差（95%一致性界限）分别为-1.8%（-28.1%至24.4%）和-1.5%（-29.3%至26.2%）。
尽管角膜地形图仪和LipiView获得的睑板腺造影参数具有相当的鉴别能力，但它们不能直接互换。总体而言，腺缺失百分比测量显示出更好的诊断性能，这将支持在可行的情况下将其用于临床试验和流行病学研究。
