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Seyer LD, Wills RW, Betbeze CM. Investigation of fluorescein stain-based tear film breakup time test reliability in dogs in a clinical setting. Am J Vet Res 2021; 82:1019-1025. [PMID: 34727069 DOI: 10.2460/ajvr.21.01.0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine intra- and interobserver reliability of a fluorescein stain-based tear film breakup time (TFBUT) test as performed in a clinical environment with and without administration of a topical anesthetic. ANIMALS 21 privately owned dogs. PROCEDURES A randomized study design was used. Two independent observers that commonly perform the TFBUT test in clinical practice read the same description of TFBUT. Observers performed TFBUT testing for each dog before and after topical administration of 0.5% proparacaine solution in 4 testing periods with a 1-hour interval between periods. Intraclass correlation coefficient (ICC) analysis was used to assess inter- and intraobserver test reliability. Linear mixed models were used to assess the main effects of testing period, observer, eye, and presence of ophthalmic disorders and their interactions on TFBUT. RESULTS Mean TFBUT measurements performed by observer 1 and observer 2 were 5.9 seconds and 8.6 seconds, respectively, when adjusted for other effects in the model. Intraobserver ICC was poor for one observer and moderate for the other. Interobserver ICC was poor without use of topical anesthetic and slightly lower when anesthetic was used. Observer and testing period were each significantly associated with TFBUT; the measurements decreased and were more variable after multiple applications of fluorescein stain and proparacaine. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested tear film stability is negatively affected by topical administration of 0.5% proparacaine solution and repeated applications of fluorescein stain. The TFBUT test as performed in this study had poor to moderate reliability.
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Affiliation(s)
- Lindsay D Seyer
- From the Departments of Clinical Sciences (Seyer, Betbeze) and Comparative Biomedical Sciences (Wills), College of Veterinary Medicine, Mississippi State University, Starkville, MS 39763
| | - Robert W Wills
- From the Departments of Clinical Sciences (Seyer, Betbeze) and Comparative Biomedical Sciences (Wills), College of Veterinary Medicine, Mississippi State University, Starkville, MS 39763
| | - Caroline M Betbeze
- From the Departments of Clinical Sciences (Seyer, Betbeze) and Comparative Biomedical Sciences (Wills), College of Veterinary Medicine, Mississippi State University, Starkville, MS 39763
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Reliability and efficacy of maximum fluorescein tear break-up time in diagnosing dry eye disease. Sci Rep 2021; 11:11517. [PMID: 34075199 PMCID: PMC8169885 DOI: 10.1038/s41598-021-91110-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/17/2021] [Indexed: 12/02/2022] Open
Abstract
This study aims to investigate the reliability and efficacy of maximum fluorescein tear break-up time (FTBUTmax) in diagnosing dry eye disease (DED). 147 participants were enrolled in this study. Ocular symptoms were assessed by Ocular Surface Disease Index (OSDI). The fluorescein tear break-up time (FTBUT) examination, corneal fluorescein staining (CFS), and Schirmer I test were performed on both eyes. Each participant underwent 3 consecutive FTBUT tests, and five types of FTBUT values including FTBUTmax, the minimum FTBUT (FTBUTmin), the first FTBUT (FTBUT1), the average of three FTBUTs (FTBUT123) and the average of the first and second FTBUT (FTBUT12) were recorded. FTBUTmax was larger than the other FTBUT values, but no differences were found among the values of FTBUT1, FTBUT123, FTBUT12 and FTBUTmin. In the ROC analysis, FTBUTmax had the largest or the second largest area under the ROC (AUROC) in all three DED diagnostic criteria, while FTBUTmin had the least AUROC of them. ROC efficacy of FTBUTmax was significantly higher than that of FTBUT123, FTBUT12, FTBUT1 and FTBUTmin in the OSDI criteria and higher than that of FTBUT1 and FTBUTmin in Schirmer I test and CFS tests. FTBUTmax has a close correlation with OSDI, Schirmer I test and CFS, and is an effective tool for the DED diagnosis.
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Yazdani M, Fiskådal J, Chen X, Utheim ØA, Ræder S, Vitelli V, Utheim TP. Tear Film Break-Up Time and Dry Eye Disease Severity in a Large Norwegian Cohort. J Clin Med 2021; 10:jcm10040884. [PMID: 33671667 PMCID: PMC7926845 DOI: 10.3390/jcm10040884] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 12/12/2022] Open
Abstract
This study evaluated to what extent tear film break-up time (TFBUT) could discriminate pathological scores for other clinical tests and explore the associations between them. Dry eye patients (n = 2094) were examined for ocular surface disease index (OSDI), tear film osmolarity (Osm), TFBUT, blink interval, ocular protection index (OPI), ocular surface staining (OSS), Schirmer I test, meibomian expressibility, meibomian quality, and meibomian gland dysfunction. The results were grouped into eight levels of break-up time (≤2, ≥3, ≤5, ≥6, ≤10, ≥11, ≤15, and ≥16) with or without sex stratification. Receiver-operating characteristic curve (ROC) analysis and Pearson’s correlation coefficients were used to study TFBUT’s discriminative power and the associations among the tests, respectively. Above and below each TFBUT’s cut-off, all of the parameters indicated significant difference between groups, except OSDI (cut-off 15 s) and Osm (cut-offs 5 s–15 s). At TFBUT cut-off of 2 s, sex difference could be detected for OSDI, Osm, and OSS. OPI presented the strongest discriminative power and association with TFBUT in sharp contrast to Osm, holding the poorest discriminative power with no significant correlation. The remaining parameters were within the poor to very poor categories, both with regard to discrimination and correlation. In conclusion, patients with lower TFBUT presented with more severe DED parameters at all four defined cut-off values.
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Affiliation(s)
- Mazyar Yazdani
- The Norwegian Dry Eye Clinic, 0366 Oslo, Norway; (J.F.); (X.C.); (Ø.A.U.); (S.R.); (T.P.U.)
- Department of Medical Biochemistry, Oslo University Hospital, 0450 Oslo, Norway
- Correspondence:
| | - Jørgen Fiskådal
- The Norwegian Dry Eye Clinic, 0366 Oslo, Norway; (J.F.); (X.C.); (Ø.A.U.); (S.R.); (T.P.U.)
| | - Xiangjun Chen
- The Norwegian Dry Eye Clinic, 0366 Oslo, Norway; (J.F.); (X.C.); (Ø.A.U.); (S.R.); (T.P.U.)
- Department of Oral Surgery and Oral Medicine, University of Oslo, 0317 Oslo, Norway
- Department of Ophthalmology, Sørlandet Hospital Arendal, 4604 Arendal, Norway
| | - Øygunn A. Utheim
- The Norwegian Dry Eye Clinic, 0366 Oslo, Norway; (J.F.); (X.C.); (Ø.A.U.); (S.R.); (T.P.U.)
- Department of Medical Biochemistry, Oslo University Hospital, 0450 Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
| | - Sten Ræder
- The Norwegian Dry Eye Clinic, 0366 Oslo, Norway; (J.F.); (X.C.); (Ø.A.U.); (S.R.); (T.P.U.)
| | - Valeria Vitelli
- Oslo Center for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway;
| | - Tor P. Utheim
- The Norwegian Dry Eye Clinic, 0366 Oslo, Norway; (J.F.); (X.C.); (Ø.A.U.); (S.R.); (T.P.U.)
- Department of Medical Biochemistry, Oslo University Hospital, 0450 Oslo, Norway
- Department of Oral Surgery and Oral Medicine, University of Oslo, 0317 Oslo, Norway
- Department of Ophthalmology, Sørlandet Hospital Arendal, 4604 Arendal, Norway
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Department of Ophthalmology, Stavanger University Hospital, 4011 Stavanger, Norway
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, 0450 Oslo, Norway
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Inanc M, Kiziltoprak H, Hekimoglu R, Tekin K, Ozalkak S, Koc M, Bayramoglu E, Zirh S, Yuruker S, Aycan Z. Alterations of Tear Film and Ocular Surface in Children with Type 1 Diabetes Mellitus. Ocul Immunol Inflamm 2020; 28:362-369. [PMID: 30806526 DOI: 10.1080/09273948.2019.1571212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To investigate whether diabetes mellitus (DM) affects ocular surface of children with well-controlled type 1 DM.Methods: Sixty-five diabetic patients and 55 age-matched controls enrolled to study. Detailed ocular surface assessment including, ocular surface disease index (OSDI) questionnaire, tear film break-up time (TBUT) analysis, Schirmer test, and conjunctival impression cytologic analysis were performed.Results: Schirmer test and TBUT results were significantly lower in DM group than controls (p = 0.001, for all). OSDI scores of all participants were within normal range. Impression cytology analysis showed grade 0 changes in all participants and there was no difference between groups for goblet cell density (p > 0.05). The TBUT results were significantly associated with duration of DM (r = -0.309, p = 0.036).Conclusion: Diabetic children without symptoms, signs, and definite diagnosis of dry eye still had lower TBUT and Schirmer test results than controls; however, impression cytology analysis was similar in both groups.
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Affiliation(s)
- Merve Inanc
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
| | - Hasan Kiziltoprak
- Department is Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Rumeysa Hekimoglu
- Histology and Embryology Department, Kastamonu University, Kastamonu, Turkey
| | - Kemal Tekin
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
| | - Servan Ozalkak
- Department of Pediatric Endocrinology, Dr. Sami Ulus Children's Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Mustafa Koc
- Department is Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Elvan Bayramoglu
- Department of Pediatric Endocrinology, Dr. Sami Ulus Children's Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Selim Zirh
- Histology and Embryology Department, Hacettepe University, Ankara, Turkey
| | - Sinan Yuruker
- Histology and Embryology Department, Usak University, Usak, Turkey
| | - Zehra Aycan
- Department of Pediatric Endocrinology, Dr. Sami Ulus Children's Health and Disease Training and Research Hospital, Ankara, Turkey
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Yazdani M, Chen X, Tashbayev B, Utheim ØA, Ræder S, Hua Y, Eidet JR, Stojanovic A, Dartt DA, Utheim TP. Evaluation of the Ocular Surface Disease Index Questionnaire as a Discriminative Test for Clinical Findings in Dry Eye Disease Patients. Curr Eye Res 2019; 44:941-947. [PMID: 30955380 DOI: 10.1080/02713683.2019.1604972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To investigate to what extent the OSDI can be utilized as a discriminative test for clinical findings. Methods: One thousand and ninety patients with dry eye disease (DED) were consecutively included and examined for osmolarity, tear film break-up time (TFBUT), ocular protection index (OPI), ocular surface staining (OSS), Schirmer I test (ST), meibum expressibility (ME), meibum quality (MQ), and diagnosis of meibomian gland dysfunction (MGD). Receiver-operating characteristic curve (ROC) analysis considering optimum balanced sensitivity and specificity (close to 50%) was used for assessment. Results: The present study on more than 1,000 patients indicates that the OSDI in the ROC curve analysis is a poor discriminator of pathological scores for TFBUT ≤ 5 (AUC = 0.553; p = .012) and ≤10 s (AUC = 0.608; p = .002), OSS ≥ 3 (AUC = 0.54; p = .043), ST ≤ 5 (AUC = 0.550; p = .032) and ≤10 mm/5 min (AUC = 0.544; p = .016), and ME ≥ 1 (AUC = 0.594; p = <0.001). Pathological scores for osmolarity >308 and >316 mOsm/L, OPI, OSS > 1, MQ, and MGD could not be discriminated by OSDI (p > .05). Conclusion: Cut-off values for the OSDI can be defined to discriminate pathological TFBUT (≤5 and ≤10), OSS (≥3), ST (≤5 and ≤10) and ME, however, the discriminability was low. Our comprehensive study emphasises the importance of taking both symptoms and signs into account in DED management.
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Affiliation(s)
- Mazyar Yazdani
- Department of Medical Biochemistry, Oslo University Hospital , Oslo , Norway.,The Norwegian Dry Eye Clinic , Oslo , Norway
| | - Xiangjun Chen
- The Norwegian Dry Eye Clinic , Oslo , Norway.,Department of Ophthalmology, Arendal Hospital , Arendal , Norway.,Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo , Oslo , Norway.,Faculty of Health Sciences, National Centre for Optics, Vision and Eye Care, University College of Southeast Norway , Kongsberg , Norway.,Department of Ophthalmology, Vestre Viken Hospital Trust , Drammen , Norway
| | - Behzod Tashbayev
- The Norwegian Dry Eye Clinic , Oslo , Norway.,Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo , Oslo , Norway
| | - Øygunn A Utheim
- Department of Medical Biochemistry, Oslo University Hospital , Oslo , Norway.,The Norwegian Dry Eye Clinic , Oslo , Norway
| | - Sten Ræder
- The Norwegian Dry Eye Clinic , Oslo , Norway
| | - Yanjun Hua
- Department of Ophthalmology, Shanghai Jiaotong University affiliated Sixth People's Hospital , Shanghai , China
| | - Jon R Eidet
- Department of Ophthalmology, Oslo University Hospital , Oslo , Norway
| | | | - Darlene A Dartt
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School , Boston , MA , USA
| | - Tor P Utheim
- Department of Medical Biochemistry, Oslo University Hospital , Oslo , Norway.,The Norwegian Dry Eye Clinic , Oslo , Norway.,Department of Ophthalmology, Arendal Hospital , Arendal , Norway.,Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo , Oslo , Norway.,Faculty of Health Sciences, National Centre for Optics, Vision and Eye Care, University College of Southeast Norway , Kongsberg , Norway.,Department of Ophthalmology, Vestre Viken Hospital Trust , Drammen , Norway.,Department of Plastic and Reconstructive Surgery, Oslo University Hospital , Oslo , Norway.,Department of maxillofacial surgery, Oslo University Hospital , Oslo , Norway.,Department of Ophthalmology, Stavanger University Hospital , Stavanger , Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen , Bergen , Norway
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Courrier E, Renault D, Kaspi M, Marcon A, Lambert V, Garcin T, Chiambaretta F, Garhofer G, Thuret G, Gain P. Micro-instillation of fluorescein with an inoculation loop for ocular surface staining in dry eye syndrome. Acta Ophthalmol 2018; 96:e140-e146. [PMID: 29068175 DOI: 10.1111/aos.13559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/06/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe and validate the micro-instillation of fluorescein on the ocular surface by a disposable calibrated inoculation loop to improve corneal and conjunctival staining quality. METHODS Accuracy and precision of the volume of 0.5% sodium fluorescein collected by a single use 1 μl-calibrated inoculation loop were measured using a precision balance. Twenty patients (40 eyes) suffering from dry eye syndrome were enrolled in a prospective interventional nonrandomized study. Fluorescein was instilled with the loop, and slit-lamp images were taken within 30 seconds using cobalt blue light with and without a yellow barrier filter. For comparison, after a washout period, the same images were retaken after instillation of one drop of fluorescein from a single-dose unit. The main outcome measure was the staining quality assessed by three experts, blind to the instillation method. Patient discomfort (tolerance, by a questionnaire) was also compared. RESULTS The mean volume collected by the loop was 1.18 ± 0.12 μl, compared with 33.70 ± 6.10 μl using the single-dose unit. The loop avoided excess dye responsible for unpleasant tearing, masking of lesions and rapid diffusion into the stroma. Micro-instillation greatly improved image quality without losing information. The yellow filter further improved image contrast. Tolerance was excellent. CONCLUSION The 1 μl-calibrated inoculation loop is a safe, convenient, inexpensive, disposable, sterile, well-tolerated tool for reproducible micro-instillation of commercial fluorescein. By greatly improving staining quality, it will help standardize assessment of dry eye severity.
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Affiliation(s)
- Emilie Courrier
- Corneal Graft Biology; Engineering and Imaging Laboratory; EA2521, SFR143; Federative Institute of Research in Sciences and Health Engineering; Faculty of Medicine; Jean Monnet University; Saint-Etienne France
| | - Didier Renault
- Corneal Graft Biology; Engineering and Imaging Laboratory; EA2521, SFR143; Federative Institute of Research in Sciences and Health Engineering; Faculty of Medicine; Jean Monnet University; Saint-Etienne France
- Laboratoires Théa; Clermont-Ferrand France
| | - Mathilde Kaspi
- Department of Ophthalmology; University Hospital; Saint-Etienne France
| | - Agathe Marcon
- Department of Ophthalmology; University Hospital; Saint-Etienne France
| | - Victor Lambert
- Department of Ophthalmology; University Hospital; Saint-Etienne France
| | - Thibaud Garcin
- Corneal Graft Biology; Engineering and Imaging Laboratory; EA2521, SFR143; Federative Institute of Research in Sciences and Health Engineering; Faculty of Medicine; Jean Monnet University; Saint-Etienne France
- Department of Ophthalmology; University Hospital; Saint-Etienne France
| | | | - Gerhard Garhofer
- Department of Clinical Pharmacology; Medical University; Vienna Austria
| | - Gilles Thuret
- Corneal Graft Biology; Engineering and Imaging Laboratory; EA2521, SFR143; Federative Institute of Research in Sciences and Health Engineering; Faculty of Medicine; Jean Monnet University; Saint-Etienne France
- Department of Ophthalmology; University Hospital; Saint-Etienne France
- Institut Universitaire de France; Paris France
| | - Philippe Gain
- Corneal Graft Biology; Engineering and Imaging Laboratory; EA2521, SFR143; Federative Institute of Research in Sciences and Health Engineering; Faculty of Medicine; Jean Monnet University; Saint-Etienne France
- Department of Ophthalmology; University Hospital; Saint-Etienne France
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Chen X, Utheim ØA, Xiao J, Adil MY, Stojanovic A, Tashbayev B, Jensen JL, Utheim TP. Meibomian gland features in a Norwegian cohort of patients with primary Sjögren´s syndrome. PLoS One 2017; 12:e0184284. [PMID: 28886085 PMCID: PMC5590907 DOI: 10.1371/journal.pone.0184284] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/21/2017] [Indexed: 12/14/2022] Open
Abstract
Purpose To assess the tear film and meibomian gland (MG) features in a Norwegian cohort of patients with primary Sjögren´s syndrome (pSS) and in age- and gender-matched control subjects. Methods Thirty-four female patients with pSS (age 52.9±11.9 years) and 32 female control subjects (age 49.0±11.5 years) were recruited. After completion of Ocular Surface Disease Index (OSDI) questionnaire and McMonnies Dry Eye Questionaire, participants underwent measurements of tear osmolarity, tear break-up time (TBUT), ocular surface and corneal staining, Schirmer I test, corneal sensitivity, MG expressibility evaluations, and lid margin morphology examination using slitlamp microscopy. Non-contact infrared meibography images were assessed by computer-assisted analysis. The MG loss, calculated as (tarsal area-MG area)/tarsal area, was evaluated in both upper (UL) and lower lids (LL). Results Compared to the control group, pSS patients demonstrated higher MG loss in both UL (33.8±13.2% vs. 24.4±8.5%, p< 0.01) and LL (52.5±15.7% vs. 43.0±9.6%, p<0.05), as well as higher lid abnormality score (0.8±0.8 vs. 0.2±0.6, p< 0.01). Furthermore, pSS patients showed higher OSDI and McMonnies questionnaire scores, elevated osmolarity, shorter TBUT, shorter blink interval, less wetting in Schirmer I test, more ocular surface staining and more corneal staining. MG loss in UL correlated negatively with TBUT (r = -0.386, p = 0.029) in the pSS group, whereas MG loss in LL correlated negatively with TBUT (r = -0.380, p = 0.035) in the control group. Conclusions Significantly elevated dry eye symptoms and signs were found in the pSS group compared with the control group, which might be attributed to both decreased aqueous tear production and increased tear evaporation.
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Affiliation(s)
- Xiangjun Chen
- Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway
- * E-mail:
| | | | - Jiaxin Xiao
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Muhammed Yasin Adil
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Behzod Tashbayev
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Janicke Liaaen Jensen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tor Paaske Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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TFOS DEWS II Diagnostic Methodology report. Ocul Surf 2017; 15:539-574. [DOI: 10.1016/j.jtos.2017.05.001] [Citation(s) in RCA: 836] [Impact Index Per Article: 119.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/01/2017] [Indexed: 01/09/2023]
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Screening for dry eye disease using infrared ocular thermography. Cont Lens Anterior Eye 2016; 39:442-449. [DOI: 10.1016/j.clae.2016.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/26/2016] [Accepted: 08/17/2016] [Indexed: 11/18/2022]
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Reliability of a new modified tear breakup time method: introduction of dry tear breakup time. Graefes Arch Clin Exp Ophthalmol 2016; 254:597. [DOI: 10.1007/s00417-015-3139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022] Open
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Reliability of a new modified tear breakup time method: methodological and statistical issues. Graefes Arch Clin Exp Ophthalmol 2015; 254:595-6. [DOI: 10.1007/s00417-015-3138-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022] Open
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