Table 7.
Diagnostic Efficacy of Tests for Evaporative and Aqueous-Deficient Dry Eye
| Test Measure | Normals vs. Dry Eye (Sens %/Spec %) | Normals vs. EDE (Sens %/Spec %) | EDE vs. ADDE (Sens %/Spec %) |
|---|---|---|---|
| Symptom questions | DE >14.5 (82/36; vs. RB, SCH, TBUT); McMonnies132 | ||
| DE >15; OSDI; (80/79 vs. Lissamine, Sch, Symp) (60/83, Dr. diagnosis); Johnson and Murphy133 | |||
| Tear stability | FBUT <10 seconds (82/86); Mengher et al.134 | ||
| Tear secretion: Schirmer I, Schirmer II | <5.5 mm/5 min (85/83); Khanal et al.92 | ||
| Index of tear volume, PRT | PRT <12 mm (56/69); Sakamoto et al.135 | ||
| PRT <20 mm (86/83); Patel et al.136 | |||
| Ocular surface damage | RB Stain >3.5; van Bijsterveld137 | ||
| RB Stain >4 (95% vs. 96%) (63/84); Vitali et al.138 | |||
| Lid (meibomian morphology) | NA | ||
| Meibomian gland expression | Expression grade >1.0* | ||
| Expressibility/volume/quality | 86/73 | ||
| Meibography | EDE ≥ 3 (83.0/90.0); Arita et al.3 | ||
| Confocal acinar unit density/diameter | Unit density <70/mm; Kobayashi et al.139; Matsumoto et al.140 (81/8) | ||
| Long diameter <65 μm (90/81) | |||
| Short diameter <25 μm (86/96) | |||
| Meibometry | NA | ||
| Interferometry | NA | ||
| Evaporation rate | DE <22 (51.1/89.9); Tomlinson et al.93 | EDE >22.3 (61.2/90.6) | EDE >27.5 (45.5/79.8) |
| Meibomian physicochemistry | |||
| Tear secretion: fluorometry, fluorescein clearance | DE <12.9 (74.5/73.6); Tomlinson et al.93 | EDE <15.1 (80.2/58.7) | ADDE <9.6 (69.5/96.8) |
| Tear volume: fluorimetry | NA | ||
| Tear meniscus height/radius/volume | DE <0.25 (74.5/73.6)-R; Yokoi and Komuro124 | ||
| DE <0.18 (72.8/66.6)-TMH; Farrell et al.141 | |||
| DE <9.6 (93.3/66.7); Mainstone et al.142 | |||
| Tear osmolarity | DE >31694 (69%/92.8%); Tomlinson et al.93 | EDE >315 (73%/72%); Khanal et al.118 | ADDE >325 (60%/39%); Khanal et al.118 |
| Tear dynamics/indices/evap/total flow | DE >15 (NA); Tomlinson et al.93 | EDE >15; Tomlinson et al.93 (na) | EDE >NA (NA) |
| Tear dynamics/indices/evaporation/TTR | DE >20 (NA); Tomlinson et al.93 | EDE >20 (NA); Tomlinson et al.93 | EDE >NA (NA) |
| Tear dynamics/indices/TFI | DE <96; Xu et al.143 | NA | |
| DE <240 (64.7/60) (83%/40%); McCann et al.144 |
The sensitivity and specificity of tests discriminating normals from dry eye and its subtypes are reported. DE, dry eye; EDE, evaporative dry eye; ADDE, aqueous-deficient dry eye; TFI, tear function index; FBUT, fluorescein break-up time; PRT, phenol red thread; RB, rose bengal; SCH, Schirmer; TBUT, tear breakup time; TTR, tear turnover rate; SENS, sensitivity; SPEC, specificity.
*
McCann LC, et al. IOVS 2008;49:ARVO E-Abstract 1532.