Blink Test enhances ability to screen for dry eye disease

Abstract

Aim: To evaluate the patient-administered Optrex^™ Dry Eye Blink Test against established clinical criteria for the diagnosis of dry eye disease (DED) and to evaluate its benefit in enhancing screening for DED.

Methods: Eighty-seven participants aged 38 ± 17 years, (44 female) were screened for DED using the Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) diagnostic criteria. In addition to symptoms screening with the Ocular Surface Disease Index questionnaire (≥13 cut-off score for DED), these criteria required a sign of loss of homeostasis of the tear film in the form of a non-invasive tear breakup time (NIBUT) <10 s (Oculus Keratograph; K5M), an osmolarity reading ≥308 mOsm/L or an interocular difference in osmolarity of >8 (Tearlab), or ocular surface staining (>5 fluorescein corneal spots, >9 lissamine green spots or lid wiper staining [≥2 mm length & ≥25% width]) to confirm a diagnosis of DED. The self-administered Blink Test, which requires the participant to observe an image on a computer screen and report the length of time (in seconds) that they can refrain from blinking without discomfort, was repeated three times.

Results: Using a cut-off time of 10 s, the Blink Test demonstrated sensitivity of 66%, specificity of 88%, and an area under the curve of 0.77 (p < 0.001), in predicting a diagnosis of DED according to the TFOS DEWS II criteria. The correlation between the Blink Test and NIBUT was r = 0.47 (p < 0.001). When combined with the screening questionnaire, the sensitivity and specificity of the Blink Test increased to 71% and 90%, respectively.

Conclusion: The Blink Test offers health professionals without advanced instrumentation, as well as patients, themselves, a rapid method of identifying possible DED.

Keywords: Blink test; Dry eye disease; Non-invasive breakup time; TFOS DEWS II.