Ma Dorothy K, Ge Yameng, Molina Alisa K, Tasho Helen, Pradhan Anisha, FazioLiu Andrea J, Ding Jennifer E, Kim Young Hyun, Ge Shaokui, Lin Meng C
Vision Science Group, Herbert Wertheim School of Optometry and Vision Science, University of California - Berkeley, Berkeley, CA, USA.
Clinical Research Center, Herbert Wertheim School of Optometry and Vision Science, University of California - Berkeley, Berkeley, CA, USA.
Transl Vis Sci Technol. 2025 Sep 2;14(9):3. doi: 10.1167/tvst.14.9.3.
The purpose of this study was to compare the diurnal patterns of tear meniscus height (TMH), traditional Schirmer strip test (TSST) wetted length, modified Schirmer strip test (MSST) wetted length, and tear aqueous production (TAP) rate.
One hundred fourteen subjects were evaluated between 7:00 and 16:00 hours. TMH (mm) was measured with the Oculus Keratograph 5M. TSST wetted length (mm) was measured without strip sheathing and topical anesthetic. The MSST with topical anesthetic and strip sheathing was used to measure wetted length (mm) and TAP rate (µL/min). The diurnal pattern was analyzed with linear mixed models which used the first visit time period as the reference and adjusted for demographic and clinical factors.
TMH was relatively stable throughout the day (P values > 0.05). TSST wetted lengths fluctuated throughout the day, but the differences were insignificant (P values > 0.05). MSST wetted length increased significantly during 13:01 to 14:00 hours and 14:01 to 15:00 hours, with adjusted mean change of 3.75 mm (95% confidence interval 0.15-7.34, P = 0.04) and 3.97 mm (95% confidence interval = 0.24-7.70, P = 0.04), respectively. TAP rate also increased significantly during 13:01 to 14:00 hours, with an adjusted mean change of 0.63 µL/min (95% confidence interval = 0.03-1.22, P = 0.04).
By adjusting for demographic and clinical confounders, this study found a distinct diurnal pattern in TAP rate and MSST wetted length. In contrast, TMH and TSST wetted length did not change significantly throughout the day. Study results accentuate the limitations of TMH and TSST wetted length for evaluating tear production.
TAP rate has the potential to provide valuable insight into tear production by evading the limitations of conventional tear volume measurements.
本研究旨在比较泪液半月板高度（TMH）、传统泪液分泌试验（TSST）湿润长度、改良泪液分泌试验（MSST）湿润长度和泪液生成率（TAP）的昼夜变化模式。
对114名受试者在7:00至16:00之间进行评估。使用Oculus Keratograph 5M测量TMH（毫米）。在不使用试纸套和局部麻醉剂的情况下测量TSST湿润长度（毫米）。使用局部麻醉剂和试纸套的MSST用于测量湿润长度（毫米）和TAP率（微升/分钟）。采用线性混合模型分析昼夜变化模式，以首次就诊时间段为参照，并对人口统计学和临床因素进行校正。
TMH在一天中相对稳定（P值>0.05）。TSST湿润长度在一天中有所波动，但差异不显著（P值>0.05）。MSST湿润长度在13:01至14:00以及14:01至15:00显著增加，校正后平均变化分别为3.75毫米（95%置信区间0.15 - 7.34，P = 0.04）和3.97毫米（95%置信区间 = 0.24 - 7.70，P = 0.04）。TAP率在13:01至14:00也显著增加，校正后平均变化为0.63微升/分钟（95%置信区间 = 0.03 - 1.22，P = 0.04）。
通过校正人口统计学和临床混杂因素，本研究发现TAP率和MSST湿润长度存在明显的昼夜变化模式。相比之下，TMH和TSST湿润长度在一天中无显著变化。研究结果突出了TMH和TSST湿润长度在评估泪液生成方面的局限性。
TAP率有可能通过规避传统泪液量测量的局限性，为泪液生成提供有价值的见解。
