Diagnostic Agreement Between Invasive and Non-invasive Assessments for Preoperative Dry Eye Disease Screening in...

The aim was to assess the incidence of dry eye disease (DED) and determine the cut-off value for non-invasive keratography tear break-up time (NIKBUT) in patients of European descent with cataracts and without significant comorbidities and to test the diagnostic agreement between invasive and non-invasive protocols.

DED symptoms and signs were evaluated preoperatively, including the SPEED II questionnaire, fluorescein break-up time (FBUT), ocular surface staining (OSS), and NIKBUT first (NIKBUT-f) and average (NIKBUT-avg). DED diagnosis was based on a SPEED score > 5 and FBUT ≤ 5 s or OSS > 1. The receiver-operating characteristic curves were determined for NIKBUT's detection of DED. The established NIKBUT-f cut-off was used instead of FBUT for alternative DED diagnostic protocols.

Out of 715 patients, 217 were eligible, with a mean age of 70.9 ± 7.9 years. Thirty per cent of patients manifested both signs and symptoms of DED; 21% had symptoms only and 22% signs only. Forty-five per cent of asymptomatic patients presented abnormal FBUT and/or OSS. FBUT was shorter than NIKBUT-f (p < 0.001, Wilcoxon) with a mean difference of 2.5 s and narrower limits of agreement for shorter BUT. The optimal diagnostic cut-off for NIKBUT-f was 7.3 s, with 69.7% sensitivity and 62.3% specificity. Replacing FBUT with the optimised NIKBUT-f threshold resulted in 2% false negatives and the highest (91%) agreement compared with other studied protocols. The fully non-invasive protocol based on SPEED and NIKBUT alone resulted in 9% of patients not being assigned to DED diagnosis.

To maximise the agreement with eye care professional diagnosis and to minimise the number of false negatives, it is recommended to decrease the standard NIKBUT-f cut-off value of 10 s for patients with cataracts. A fully non-invasive approach will result in fewer patients being referred for preoperative eye surface treatment. Ocular staining should not be omitted from the DED diagnosis.