Classification of Fluorescein Breakup Patterns: A Novel Method of Differential Diagnosis for Dry Eye

To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases. Cross-sectional study. In 106 eyes of 106 subjects (19 male, 87 female; mean age: 64.2 years), FBUPs were categorized into 1 of the following 5 break (B) types: area (AB, n = 19...

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Published in	American journal of ophthalmology Vol. 180; pp. 72 - 85
Main Authors	Yokoi, Norihiko, Georgiev, Georgi As, Kato, Hiroaki, Komuro, Aoi, Sonomura, Yukiko, Sotozono, Chie, Tsubota, Kazuo, Kinoshita, Shigeru
Format	Journal Article
Language	English
Published	United States Elsevier Inc 01.08.2017 Elsevier Limited
Subjects	Aged Automobiles Classification Contact angle Cornea Cross-Sectional Studies Diagnosis, Differential Dry Eye Syndromes - diagnosis Dry Eye Syndromes - metabolism Eye care products Female Fluorescein - metabolism Fluorescent Dyes - metabolism Fluorophotometry - classification Fluorophotometry - methods Humans Male Medical diagnosis Methods Middle Aged Ophthalmology Surveys and Questionnaires Tears - metabolism tear abnormalities dry eye symptoms dry eye ocular surface epithelial abnormalities fluorescein breakup patterns
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Abstract	To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases. Cross-sectional study. In 106 eyes of 106 subjects (19 male, 87 female; mean age: 64.2 years), FBUPs were categorized into 1 of the following 5 break (B) types: area (AB, n = 19); spot (SB, n = 22); line (LB, n = 24); dimple (DB, n = 19); random (RB, n = 22 eyes); and dry eye–related symptoms using the visual analog scale (VAS, 100 mm = maximum), tear meniscus radius (TMR, mm), tear film lipid layer interference grade (IG) (grades 1–5; 1 = best) and spread grade (SG) (grades 1–4; 1 = best), tear film noninvasive breakup time (NIBUT, seconds), fluorescein breakup time (FBUT, seconds), corneal-epithelial damage (CED) score (15 points = maximum), ocular surface epithelial damage (OSED) score (9 points = maximum), and the Schirmer 1 test (ST1, mm) were examined and compared between each FBUP. In each FBUP, eye dryness and fatigue were the severest symptoms. Characteristic symptoms were sensitivity to light, heavy eyelids, pain, foreign body sensation, difficulty opening the eye, and discharge for AB, heavy eyelids for SB, and foreign-body sensation for LB. Statistically significant differences were found in TMR (AB-SB, -DB, and -RB; LB-RB), IG (AB-all other FBUP; LB-SB and -DB), and SG (AB-all other FBUPs), FBUT (AB-LB, -DB, and -RB; SB-DB and -RB; LB-RB; DB-RB), and NIBUT (AB-all other FBUPs; SB-DB and-RB, and LB-RB), CED (AB-all other FBUPs; LB-SB, -DB, and -RB) and OSED (AB-SB, -LB, and -DB; LB-SB, -DB, and -RB), and ST1 (AB-SB, -DB, and -LB) (P < .05 in each comparison). The 5 different FBUPs constituted different groups, reflecting different pathophysi-ologies.
AbstractList	To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases. Cross-sectional study. In 106 eyes of 106 subjects (19 male, 87 female; mean age: 64.2 years), FBUPs were categorized into 1 of the following 5 break (B) types: area (AB, n = 19); spot (SB, n = 22); line (LB, n = 24); dimple (DB, n = 19); random (RB, n = 22 eyes); and dry eye-related symptoms using the visual analog scale (VAS, 100 mm = maximum), tear meniscus radius (TMR, mm), tear film lipid layer interference grade (IG) (grades 1-5; 1 = best) and spread grade (SG) (grades 1-4; 1 = best), tear film noninvasive breakup time (NIBUT, seconds), fluorescein breakup time (FBUT, seconds), corneal-epithelial damage (CED) score (15 points = maximum), ocular surface epithelial damage (OSED) score (9 points = maximum), and the Schirmer 1 test (ST1, mm) were examined and compared between each FBUP. In each FBUP, eye dryness and fatigue were the severest symptoms. Characteristic symptoms were sensitivity to light, heavy eyelids, pain, foreign body sensation, difficulty opening the eye, and discharge for AB, heavy eyelids for SB, and foreign-body sensation for LB. Statistically significant differences were found in TMR (AB-SB, -DB, and -RB; LB-RB), IG (AB-all other FBUP; LB-SB and -DB), and SG (AB-all other FBUPs), FBUT (AB-LB, -DB, and -RB; SB-DB and -RB; LB-RB; DB-RB), and NIBUT (AB-all other FBUPs; SB-DB and-RB, and LB-RB), CED (AB-all other FBUPs; LB-SB, -DB, and -RB) and OSED (AB-SB, -LB, and -DB; LB-SB, -DB, and -RB), and ST1 (AB-SB, -DB, and -LB) (P < .05 in each comparison). The 5 different FBUPs constituted different groups, reflecting different pathophysi-ologies. Purpose To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases. Design Cross-sectional study. Methods In 106 eyes of 106 subjects (19 male, 87 female; mean age: 64.2 years), FBUPs were categorized into 1 of the following 5 break (B) types: area (AB, n = 19); spot (SB, n = 22); line (LB, n = 24); dimple (DB, n = 19); random (RB, n = 22 eyes); and dry eye-related symptoms using the visual analog scale (VAS, 100 mm = maximum), tear meniscus radius (TMR, mm), tear film lipid layer interference grade (IG) (grades 1-5; 1 = best) and spread grade (SG) (grades 1-4; 1 = best), tear film noninvasive breakup time (NIBUT, seconds), fluorescein breakup time (FBUT, seconds), corneal-epithelial damage (CED) score (15 points = maximum), ocular surface epithelial damage (OSED) score (9 points = maximum), and the Schirmer 1 test (ST1, mm) were examined and compared between each FBUP. Results In each FBUP, eye dryness and fatigue were the severest symptoms. Characteristic symptoms were sensitivity to light, heavy eyelids, pain, foreign body sensation, difficulty opening the eye, and discharge for AB, heavy eyelids for SB, and foreign-body sensation for LB. Statistically significant differences were found in TMR (AB-SB, -DB, and -RB; LB-RB), IG (AB-all other FBUP; LB-SB and -DB), and SG (AB-all other FBUPs), FBUT (AB-LB, -DB, and -RB; SB-DB and -RB; LB-RB; DB-RB), and NIBUT (AB-all other FBUPs; SB-DB and-RB, and LB-RB), CED (AB-all other FBUPs; LB-SB, -DB, and -RB) and OSED (AB-SB, -LB, and -DB; LB-SB, -DB, and -RB), and ST1 (AB-SB, -DB, and -LB) (P< .05 in each comparison). Conclusions The 5 different FBUPs constituted different groups, reflecting different pathophysi-ologies. To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases.PURPOSETo investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases.Cross-sectional study.DESIGNCross-sectional study.In 106 eyes of 106 subjects (19 male, 87 female; mean age: 64.2 years), FBUPs were categorized into 1 of the following 5 break (B) types: area (AB, n = 19); spot (SB, n = 22); line (LB, n = 24); dimple (DB, n = 19); random (RB, n = 22 eyes); and dry eye-related symptoms using the visual analog scale (VAS, 100 mm = maximum), tear meniscus radius (TMR, mm), tear film lipid layer interference grade (IG) (grades 1-5; 1 = best) and spread grade (SG) (grades 1-4; 1 = best), tear film noninvasive breakup time (NIBUT, seconds), fluorescein breakup time (FBUT, seconds), corneal-epithelial damage (CED) score (15 points = maximum), ocular surface epithelial damage (OSED) score (9 points = maximum), and the Schirmer 1 test (ST1, mm) were examined and compared between each FBUP.METHODSIn 106 eyes of 106 subjects (19 male, 87 female; mean age: 64.2 years), FBUPs were categorized into 1 of the following 5 break (B) types: area (AB, n = 19); spot (SB, n = 22); line (LB, n = 24); dimple (DB, n = 19); random (RB, n = 22 eyes); and dry eye-related symptoms using the visual analog scale (VAS, 100 mm = maximum), tear meniscus radius (TMR, mm), tear film lipid layer interference grade (IG) (grades 1-5; 1 = best) and spread grade (SG) (grades 1-4; 1 = best), tear film noninvasive breakup time (NIBUT, seconds), fluorescein breakup time (FBUT, seconds), corneal-epithelial damage (CED) score (15 points = maximum), ocular surface epithelial damage (OSED) score (9 points = maximum), and the Schirmer 1 test (ST1, mm) were examined and compared between each FBUP.In each FBUP, eye dryness and fatigue were the severest symptoms. Characteristic symptoms were sensitivity to light, heavy eyelids, pain, foreign body sensation, difficulty opening the eye, and discharge for AB, heavy eyelids for SB, and foreign-body sensation for LB. Statistically significant differences were found in TMR (AB-SB, -DB, and -RB; LB-RB), IG (AB-all other FBUP; LB-SB and -DB), and SG (AB-all other FBUPs), FBUT (AB-LB, -DB, and -RB; SB-DB and -RB; LB-RB; DB-RB), and NIBUT (AB-all other FBUPs; SB-DB and-RB, and LB-RB), CED (AB-all other FBUPs; LB-SB, -DB, and -RB) and OSED (AB-SB, -LB, and -DB; LB-SB, -DB, and -RB), and ST1 (AB-SB, -DB, and -LB) (P < .05 in each comparison).RESULTSIn each FBUP, eye dryness and fatigue were the severest symptoms. Characteristic symptoms were sensitivity to light, heavy eyelids, pain, foreign body sensation, difficulty opening the eye, and discharge for AB, heavy eyelids for SB, and foreign-body sensation for LB. Statistically significant differences were found in TMR (AB-SB, -DB, and -RB; LB-RB), IG (AB-all other FBUP; LB-SB and -DB), and SG (AB-all other FBUPs), FBUT (AB-LB, -DB, and -RB; SB-DB and -RB; LB-RB; DB-RB), and NIBUT (AB-all other FBUPs; SB-DB and-RB, and LB-RB), CED (AB-all other FBUPs; LB-SB, -DB, and -RB) and OSED (AB-SB, -LB, and -DB; LB-SB, -DB, and -RB), and ST1 (AB-SB, -DB, and -LB) (P < .05 in each comparison).The 5 different FBUPs constituted different groups, reflecting different pathophysi-ologies.CONCLUSIONSThe 5 different FBUPs constituted different groups, reflecting different pathophysi-ologies. Abstract Purpose To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry-eye cases. Design Cross-sectional study. Methods In 106 eyes of 106 subjects (19 males, 87 females; mean age: 64.2 years), FBUPs were categorized into 1 of the following 5 break (B) types: area (AB, n=19); spot (SB, n=22); line (LB, n=24); dimple (DB, n=19); random (RB, n=22 eyes), and dry-eye-related symptoms using the visual analog scale (VAS, 100mm=maximum), tear meniscus radius (TMR, mm), tear-film lipid-layer interference grade (IG) (grades 1-5; 1=best) and spread grade (SG) (grades 1-4; 1=best), tear-film non-invasive breakup time (NIBUT, seconds), FBU time (FBUT, seconds), corneal-epithelial damage (CED) score (15 points=maximum), ocular-surface epithelial damage (OSED) score (9 points=maximum), and the Schirmer 1 test (ST1, mm) were examined and compared between each FBUP. Results In each FBUP, eye dryness and fatigue were the severest symptoms. Characteristic symptoms were sensitivity to light, heavy eyelids, pain, foreign-body sensation, difficulty opening the eye, and discharge for AB, heavy eyelids for SB, foreign-body sensation for LB. Statistically significant differences were found in TMR (AB-SB, -DB and -RB; LB-RB), IG (AB-all other FBUP; LB-SB and -DB), and SG (AB-all other FBUPs), FBUT (AB-LB, -DB, and –RB; SB-DB and –RB; LB-RB; DB-RB), and NIBUT (AB-all other FBUPs; SB-DB and-RB, and LB-RB), CED (AB-all other FBUPs; LB-SB, -DB, and -RB) and OSED (AB-SB, -LB, and -DB; LB-SB, -DB, and -RB), and ST1 (AB-SB, -DB, and -LB) (p<0.05 in each comparison). Conclusions The 5 different FBUPs constituted different groups, reflecting different pathophysiologies.
Author	Kato, Hiroaki Georgiev, Georgi As Sonomura, Yukiko Yokoi, Norihiko Kinoshita, Shigeru Sotozono, Chie Tsubota, Kazuo Komuro, Aoi
Author_xml	– sequence: 1 givenname: Norihiko surname: Yokoi fullname: Yokoi, Norihiko email: nyokoi@koto.kpu-m.ac.jp organization: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan – sequence: 2 givenname: Georgi As surname: Georgiev fullname: Georgiev, Georgi As organization: Department of Optics and Spectroscopy, Faculty of Physics, St. Kliment Ohridski University of Sofia, Sofia, Bulgaria – sequence: 3 givenname: Hiroaki surname: Kato fullname: Kato, Hiroaki organization: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan – sequence: 4 givenname: Aoi surname: Komuro fullname: Komuro, Aoi organization: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan – sequence: 5 givenname: Yukiko surname: Sonomura fullname: Sonomura, Yukiko organization: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan – sequence: 6 givenname: Chie surname: Sotozono fullname: Sotozono, Chie organization: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan – sequence: 7 givenname: Kazuo surname: Tsubota fullname: Tsubota, Kazuo organization: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan – sequence: 8 givenname: Shigeru surname: Kinoshita fullname: Kinoshita, Shigeru organization: Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/28579061$$D View this record in MEDLINE/PubMed
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Keywords	tear abnormalities dry eye symptoms dry eye ocular surface epithelial abnormalities fluorescein breakup patterns
Language	English
License	Copyright © 2017 Elsevier Inc. All rights reserved.
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Snippet	To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases. Cross-sectional study. In 106 eyes... Abstract Purpose To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry-eye cases. Design... Purpose To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases. Design Cross-sectional... To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases.PURPOSETo investigate the...
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SubjectTerms	Aged Automobiles Classification Contact angle Cornea Cross-Sectional Studies Diagnosis, Differential Dry Eye Syndromes - diagnosis Dry Eye Syndromes - metabolism Eye care products Female Fluorescein - metabolism Fluorescent Dyes - metabolism Fluorophotometry - classification Fluorophotometry - methods Humans Male Medical diagnosis Methods Middle Aged Ophthalmology Surveys and Questionnaires Tears - metabolism
Title	Classification of Fluorescein Breakup Patterns: A Novel Method of Differential Diagnosis for Dry Eye
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