The relationship of pre-corneal to pre-contact lens non-invasive tear breakup time.

Andrew D Graham,Meng C Lin,Blanka Golebiowski

doi:10.1371/journal.pone.0247877

Andrew D Graham, Meng C Lin + Show 1 more

Open Access

https://doi.org/10.1371/journal.pone.0247877

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Journal: PloS one	Publication Date: Jun 28, 2021
Citations: 6	License type: CC BY 4.0

Affiliation: University of California, Berkeley

Abstract

PurposeTo examine the relationship between pre-corneal and pre-contact lens tear film stability (TFS), and to determine whether pre-corneal TFS is a reliable predictor of subsequent pre-lens TFS after a contact lens is placed on the eye.Methods667 records met inclusion criteria and were extracted from a soft contact lens multi-study database. Multivariable linear mixed effects models were fit to examine the association between pre-corneal and pre-lens TFS, adjusting for potential confounders and accounting for repeated measures. Receiver Operating Characteristic (ROC) analysis was employed to assess the predictive performance of pre-corneal TFS for subsequent pre-lens TFS. TFS was quantified for this analysis as the non-invasive tear breakup time (NITBUT).ResultsPre-corneal NITBUT was significantly related to the pre-lens NITBUT at both 10 min (p<0.001) and 2–6 hrs (p<0.001) post-lens insertion. However, the sensitivities of pre-corneal NITBUT for predicting symptom-associated thresholds of pre-lens NITBUT ranged from 50–65%, and specificities ranged from 57–72%, suggesting poor-to-moderate diagnostic performance.ConclusionsDespite the association of pre-corneal and pre-lens TFS, the inherent lability and sensitivity to environmental exposures of the tear film introduce significant variability into NITBUT measurements. Using pre-corneal NITBUT to identify likely successful contact lens candidates prior to fitting is thus not sufficiently accurate to be relied upon in the clinical setting.

Highlights

Despite continual technical advances and improvements in soft contact lens wear, symptoms of dryness and discomfort, often leading to patient discontinuation, continue to be of substantial concern [1,2,3,4]
The sensitivities of pre-corneal non-invasive tear breakup time (NITBUT) for predicting symptom-associated thresholds of pre-lens NITBUT ranged from 50–65%, and specificities ranged from 57–72%, suggesting poor-to-moderate diagnostic performance
Rohit et al found a significant relationship between ocular comfort and lens surface drying time measured non-invasively in 40 habitual soft contact lens wearers (p = 0.003), the model did not explain a large proportion of the variability (r = 0.21) [17]

Summary

Introduction

Despite continual technical advances and improvements in soft contact lens wear, symptoms of dryness and discomfort, often leading to patient discontinuation, continue to be of substantial concern [1,2,3,4]. When a contact lens is placed on the eye, the pre-corneal tear film is compartmentalized into pre-lens and post-lens segments, each thinner than the original precorneal tear film. A tear film that is stable between blinks is widely agreed to be a necessity for comfort during contact lens wear [16, 17], but the compartmentalization of the tear film into two thinner segments by the lens can result in a destabilization of this important thin film over the lens surface [18, 19] and increased ocular dryness and discomfort [20]. From numerous studies employing different measures of pre-lens tear film stability, and assessing different subjective outcomes, it has become widely accepted that a primary factor in contact lens discomfort, dryness and dissatisfaction is an unstable pre-lens tear film [20]

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