Abstract
The prevalence of dry eye disease (DED) is increasing worldwide, and its diagnosis often needs dedicated reagents and machines. We investigated the usefulness of maximum blink interval (MBI) (the length of time that participants could keep their eyes open) in screening for DED. This cross-sectional study included 292 patients (194 with DED and 98 without DED) recruited between September 2016 and September 2017. We compared the MBI between patients with and without DED; examined correlations between MBI and other clinical features of DED, including subjective symptoms (Dry Eye-Related Quality-of-Life Score), tear film breakup time (TFBUT), cornea fluorescence score (CFS), and Schirmer test I value; and determined the optimal cutoff value of MBI to suspect DED using a receiver operating characteristic (ROC) analysis. The MBI was significantly shortened in DED group compared to the non-DED group (10.0 ± 9.1 vs. 24.3 ± 38.2 seconds, p < 0.001). TFBUT was strongly positively correlated with MBI (r = 0.464), whereas CFS was negatively correlated with MBI (r = −0.273). The area under the ROC curve was 0.677, and the optimal MBI cutoff value was 12.4 seconds, providing a sensitivity of 82.5% and specificity of 51.0% to suspect DED. In conclusion, MBI may be a simple, useful test for screening DED.
Highlights
Dry eye disease (DED), a disorder of the tear film due to tear deficiency or excessive tear evaporation, damages the interpalpebral ocular surface and is associated with symptoms of ocular discomfort[1]
The new diagnostic criteria for dry eye disease (DED) have been recommended by Asia Dry Eye Society (ADES), and the diagnosis of DED can be made by subjective symptoms and decreased TFBUT19
We showed the usefulness of maximum blink interval (MBI) measurement as a simple DED screening method
Summary
Dry eye disease (DED), a disorder of the tear film due to tear deficiency or excessive tear evaporation, damages the interpalpebral ocular surface and is associated with symptoms of ocular discomfort[1]. DED is diagnosed by triaging questions; risk factor analysis; diagnostic tests, such as questionnaire, non-invasive tear film breakup time (TFBUT), osmolality measurements and ocular surface staining[2]. Periodic blinking rate can be affected by various factors, such as fatigue, eye injury, medication, diseases, and dryness[10,12,13]. We aimed to assess the usefulness of MBI in screening for DED by (i) comparing MBI between non-DED and DED patients, (ii) examining correlations between MBI and other test results for DED assessment, and (iii) conducting a receiver operating characteristic (ROC) analysis to identify the optimal MBI cutoff value to suspect DED. We assessed the blink interval period (BIP), which is the difference between MBI and TFBUT, to explore the mechanism of MBI
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