Agreement Between Tear Film Tests Performed by Novice Examiners

Area of Science:

• Ophthalmology
• Optometry
• Tear Film Research

Background:

• Tear film stability is crucial for ocular surface health.
• Accurate tear break-up time (TBUT) measurements are essential for diagnosing dry eye disease.
• Novice examiners' impact on TBUT measurement reliability is not well-established.

Purpose of the Study:

• To assess the agreement among manual non-invasive tear break-up time (mNIBUT), automated non-invasive tear break-up time (aNIBUT), and fluorescein tear break-up time (FBUT) measurements performed by novice examiners.
• To investigate the correlation between tear film metrics and ocular surface disease index (OSDI) symptoms.

Main Methods:

• 61 volunteers underwent tear film assessments by undergraduate students.
• Measurements included tear volume (Schirmer test), mNIBUT, aNIBUT, FBUT, and lipid layer pattern.
• Ocular surface discomfort and tear film quality symptoms were evaluated using the OSDI questionnaire.

Main Results:

• Intraclass correlation coefficients indicated poor reliability between mNIBUT, aNIBUT, and FBUT, except between mNIBUT and FBUT.
• Bland-Altman analysis revealed wider limits of agreement for mNIBUT-aNIBUT and FBUT-aNIBUT compared to FBUT-mNIBUT.
• No significant correlations were found between OSDI scores and tear metrics in this largely asymptomatic cohort.

Conclusions:

• Tear break-up time measurements by novice examiners exhibit limited reliability and agreement across different methods.
• Examiner variability may impact tear film stability assessment.
• Measurement repetition did not enhance reliability among novice examiners.