Abstract
Background Dry eye disease (DED) is a multifactorial and one of the most common problems treated in an ophthalmic outpatient clinic. Due to the variability in presentation, diagnosis of DED consists of a combination of subjective and objective clinical tests. The purpose of this study was to assess the effectiveness of a handheld smartphone-based infrared thermal (IRT) camera for screening symptomatic evaporative DED. Methods This observational sex-matched control study assessed IRT images of 184 right eyes (46 normal and 138 DED) of 184 participants. Evaporative DED was assessed using noninvasive tear breakup time, fluorescein staining, and the Chinese version of the ocular surface disease index (C-OSDI) questionnaire and categorized into their respective dry eye symptomology group (none, mild, moderate, or severe). The ocular surface temperature (OST) at 8 anatomical regions of interest (ROI) (nasal conjunctiva, nasal limbus, nasal cornea, central cornea, inferior cornea, temporal limbus, temporal cornea, and temporal conjunctiva) were measured and compared using a handheld smartphone-based IRT camera. The effectiveness of these 8 ROIs OST in detecting varying severity of DED was evaluated in terms of correlations with severity of DED and their area under the curve (AUC). Results OST at the 8 anatomical ROI was significantly higher in DED participants than in the non-DED group (p < 0.05) except for inferior cornea, temporal limbus, and temporal conjunctival regions (>0.05). Analyzing 8 anatomical ROIs revealed that the nasal limbus had the highest Pearson correlation with the severity of DED (0.64, p < 0.001). Additionally, the nasal limbus ROI achieved the highest AUC of 0.79 (CI: 0.73–0.85; p < 0.05), sensitivity, and specificity (0.96 and 0.91) when comparing its ability to discriminated DED vs. non-DED eyes. Conclusions Rather than a diagnostic tool, handheld smartphone-based IRT images can be considered as a rapid, noninvasive, and hygienic screening tool in discriminating DED and non-DED and potentially alleviating inconvenience experienced during conventional tests.
Highlights
Dry eye disease (DED) is a prevalent ocular condition that may result in ocular pain, decreased visual acuity, and decreased eyesight and quality of life [1,2,3]
Receiver operating characteristic (ROC) curves were used to analyze the screening potential for DED, and the areas under the ROC curves (AUC) were calculated. e average temperature was calculated by assessing the mean value of all the eight regions of interest (ROI) of an individual eye. e level of statistical significance was set at p < 0.05
The highest mean ocular surface temperature (OST) was recorded on the nasal limbus anatomical ROI in all groups, while the lowest mean OST was recorded on the temporal conjunctiva anatomical ROI in all groups
Summary
Dry eye disease (DED) is a multifactorial and one of the most common problems treated in an ophthalmic outpatient clinic. E purpose of this study was to assess the effectiveness of a handheld smartphone-based infrared thermal (IRT) camera for screening symptomatic evaporative DED. E ocular surface temperature (OST) at 8 anatomical regions of interest (ROI) (nasal conjunctiva, nasal limbus, nasal cornea, central cornea, inferior cornea, temporal limbus, temporal cornea, and temporal conjunctiva) were measured and compared using a handheld smartphone-based IRT camera. The nasal limbus ROI achieved the highest AUC of 0.79 (CI: 0.73–0.85; p < 0.05), sensitivity, and specificity (0.96 and 0.91) when comparing its ability to discriminated DED vs non-DED eyes. Rather than a diagnostic tool, handheld smartphone-based IRT images can be considered as a rapid, noninvasive, and hygienic screening tool in discriminating DED and non-DED and potentially alleviating inconvenience experienced during conventional tests
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