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Image-based quantitative analysis of tear film lipid layer thickness for meibomian gland evaluation.

ABSTRACT: Dry eye syndrome is one of the most common ocular diseases, and meibomian gland dysfunction (MGD) is the leading cause of evaporative dry eye syndrome. When the tear film lipid layer becomes thin due to obstructive or hyposecretory meibomian gland dysfunction, the excessive evaporation of the aqueous layer can occur, and this causes evaporative dry eye syndrome. Thus, measuring the lipid layer thickness (LLT) is essential for accurate diagnosis and proper treatment of evaporative dry eye syndrome.We used a white LED panel with a slit lamp microscope to obtain videos of the lipid layer interference patterns on the cornea. To quantitatively analyze the LLT from interference colors, we developed a novel algorithm that can automatically perform the following processes on an image frame: determining the radius of the iris, locating the center of the pupil, defining region of interest (ROI), tracking the ROI, compensating for the color of iris and illumination, and producing comprehensive analysis output. A group of dry eye syndrome patients with hyposecretory MGD, dry eye syndrome without MGD, hypersecretory MGD, and healthy volunteers were recruited. Their LLTs were analyzed and statistical information-mean and standard deviation, the relative frequency of LLT at each time point, and graphical LLT visualization-were produced.Using our algorithm, we processed the lipid layer interference pattern and automatically analyzed the LLT distribution of images from patients. The LLT of hyposecretory MGD was thinner (45.2 ± 11.6 nm) than that of dry eye syndrome without MGD (69.0 ± 9.4 nm) and healthy volunteers (68.3 ± 13.7 nm) while the LLT of hypersecretory MGD was thicker (93.5 ± 12.6 nm) than that of dry eye syndrome without MGD. Patients' LLTs were statistically analyzed over time, visualized with 3D surface plots, and displayed using 3D scatter plots of image pixel data for comprehensive assessment.We developed an image-based algorithm for quantitative measurement as well as statistical analysis of the LLT despite fluctuation and eye movement. This pilot study demonstrates that the quantitative LLT analysis of patients is consistent with the functions of meibomian glands clinically evaluated by an ophthalmologist. This approach is a significant step forward in developing a fully automated instrument for evaluating dry eye syndrome and for providing proper guidance of treatment.

SUBMITTER: Hwang H

PROVIDER: S-EPMC5701431 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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Image-based quantitative analysis of tear film lipid layer thickness for meibomian gland evaluation.

Hwang Hyeonha H Jeon Hee-Jae HJ Yow Kin Choong KC Hwang Ho Sik HS Chung EuiHeon E

Biomedical engineering online 20171123 1

<h4>Background</h4>Dry eye syndrome is one of the most common ocular diseases, and meibomian gland dysfunction (MGD) is the leading cause of evaporative dry eye syndrome. When the tear film lipid layer becomes thin due to obstructive or hyposecretory meibomian gland dysfunction, the excessive evaporation of the aqueous layer can occur, and this causes evaporative dry eye syndrome. Thus, measuring the lipid layer thickness (LLT) is essential for accurate diagnosis and proper treatment of evaporat ...[more]

PMID: 29169367

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Project description:BackgroundTo evaluate the correlations between lipid layer thickness (LLT) and morphology and function of the meibomian glands in patients who were diagnosed as meibomian gland dysfunction (MGD) in different age groups.MethodsPatients who have diagnosed as obstructive MGD were included in this prospective, cross-sectional study. Patients were divided into three groups: young (ages 20-39 years), middle-aged (ages 40-59 years), and older (aged ≥60 years). All patients completed an Ocular Surface Disease Index (OSDI) questionnaire and were evaluated for LLT, tear meniscus height (TMH), noninvasive tear film break-up time (NI-BUT) measurement, invasive TBUT (ITBUT), corneal fluoresceinstaining (CFS) score, eyelid margin abnormalities, Schirmer I test, and MG function and morphology, by using the Keratograph 5 and LipiView interferometer.ResultsTwo hundred and nine patients (209 eyes) were included. The median LLT of all patient was 57 nm (IQR, 36.5 nm), and the LLT values were significantly different among the young group (median, 51 nm; IQR, 23.5 nm), middle-aged group (median, 59.5 nm; IQR 46.5 nm) and older group (median, 62 nm; IQR, 42.5 nm) (P = 0.033, Kruskal-Wallis test). In regression analyses controlling for confounder factors sex and MG loss, the LLT was positively correlated with age (β = 5.539, P = 0.001). There was a negative correlation between LLT and MG dropout in the all (r = - 0.527, P < 0.001), young (r = - 0.536, P < 0.001), middle-aged (r = - 0.576, P < 0.001), and older (r = - 0.501, P < 0.001) groups. LLT was positively correlated with the MG expressibility in the all (r = 0.202, P = 0.003), middle-aged (r = 0.280, P = 0.044) and older (r = 0.452, p < 0.001) groups, but it was no statistical significance in the young group (r = 0.007, P = 0.949).ConclusionsThe thickness of LLT was increased with age and significantly correlated with both MG secretion and morphology in middle-aged and older patients with obstructive MGD. LLT measurement is a useful screening tool for detecting obstructive MGD and age as an influential factor should be accounted for when interpreting the meaning of the LLT value.Trial registrationNCT02481167 ; Registered 25 June, 2015.

Project description:OBJECTIVE:To elucidate the relationship between lipid layer thickness (LLT), incomplete blinking rate and tear film stability in patients with different myopia degrees after small-incision lenticule extraction (SMILE) and to determine whether there is a difference in the prevalence of dry eye disease (DED) after SMILE among patients with different myopia degrees. METHODS:Fifty patients (100 eyes) were enrolled in this study; they were divided into 3 groups according to the degree of spherical refraction: a low-myopia group (LMG; spherical refraction ≤-3.00 D, 20 eyes), a moderate-myopia group (MMG; -3.00 D < spherical refraction <-6.00 D, 40 eyes), and a high-myopia group (HMG; spherical refraction ≧-6.00 D, 40 eyes). Testing indicators included the ocular surface disease index (OSDI), fluorescein tear film breakup time (FBUT), corneal fluorescence staining (CFS), the Schirmer test (SI), lipid layer thickness (LLT), blink rate (BR) per 20 seconds, incomplete blinking rate, noninvasive keratograph assessment of first and average tear film breakup time (NIKBUTf, NIKBUTav), and tear meniscus height (TMH). Each indicator was evaluated preoperatively and postoperatively at 1 w, 1 mo and 3 mo. RESULTS:The mean age was 29.12±5.95 years. There were no significant differences among the three groups (p>0.05), except preoperative age (p = 0.006). There were significant differences in the FBUT among the three groups at postoperative 1 w and 1 mo (p<0.05). There were significant differences in the incomplete blinking rate and FBUT between the LMG and the HMG at postoperative 1 mo (p<0.05). The number of first tear film breakup points located beyond the 6 mm diameter of the cornea was higher in the HMG than in the other groups. The prevalence of DED in the LMG, the MMG, the HMG was 15%, 8% and 23%, respectively, at 1 w postoperative and 30%, 45% and 53%, respectively, at postoperative 1 mo. The change in LLT was significantly correlated with the changes in FBUT (r = 0.408, p<0.001) and incomplete blinking rate (r = -0.266, p = 0.007). The change in OSDI was negatively correlated with the change in SI (r = -0.502, p = 0.000). CONCLUSIONS:The changes in LLT and incomplete blinking rate decreased the stability of the tear film. The changes in LLT, FBUT and incomplete blinking rate differed postoperatively with different myopia degrees. The prevalence of DED was higher in the HMG than in the other two groups.

Dataset Information

Image-based quantitative analysis of tear film lipid layer thickness for meibomian gland evaluation.

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Image-based quantitative analysis of tear film lipid layer thickness for meibomian gland evaluation.

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