Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May;34(5):915-922.
doi: 10.1038/s41433-019-0592-y. Epub 2019 Oct 1.

Corneal epithelial thickness profile in dry-eye disease

Mohamed Abou Shousha  1 , Jianhua Wang  1 , George Kontadakis  1 , William Feuer  1 , Ana P Canto  1 , Rodrigo Hoffmann  1 , Victor L Perez  2   3
Affiliations

Corneal epithelial thickness profile in dry-eye disease

Mohamed Abou Shousha et al. Eye (Lond). 2020 May.

Abstract

Background/objectives: To characterize and evaluate the use of corneal epithelial profile maps generated by an ultrahigh-resolution optical coherence tomography (UHR-OCT) in the diagnosis and management of dry-eye disease (DED).

Subjects/methods: This prospective, interventional case-control study included 115 eyes of 71 subjects (52 DED and 19 controls) imaged using an UHR-OCT. Average, maximum, and minimum, range of corneal epithelial thicknesses were extracted from epithelial profile maps. Surface regularity was quantified using the range and variance of the epithelial thickness measured along a horizontal UHR-OCT scan. The variance of thickness measurements along a scan was named epithelial irregularity factor (EIF). Symptoms of 31 DED patients (55 eyes) were quantified by questionnaire and correlated to epithelial profile findings, fluorescein staining, tear breakup time, and Schirmer's test. Twenty-one DED eyes were administered autologous serum drops and follow-up UHR-OCT images were captured.

Results: DED patients had a highly irregular corneal epithelial surface compared with controls. Epithelial thickness profile variance (EIF) and range were significantly higher in DED as compared with controls (5.79 vs. 0.77, p < 0.001 and 7.6 vs. 4.6 μm, p < 0.001). Both parameters were highly significantly correlated with questionnaire scores (EIF: r = 0.778; p < 0.001, range: r = 0.737; p < 0.001). Follow-up showed a statistically significant reduction in epithelial thickness profile variance and range of treated patients ( p < 0.001).

Conclusions: DED patients have irregular epithelial surface that can be quantified using UHR-OCT generated CEP maps. Epithelial thickness profile range and EIF correlate accurately with patients' symptoms and could be used to follow-up patients and response to treatment.

PubMed Disclaimer

Conflict of interest statement

VLP is a consultant of Alcon Ltd. MAS and VLP are equity holders and sit on the Board of Directors for Resolve Ophthalmics, LLC. They are co-inventor of intellectual property licensed to Resolve Ophthalmics. PCT/US2018/013409, and US Patent No 8992023. VLP, MAS, and JW are co-inventor of Non-Provisional United States Patent Application No.: 61809518.

Figures

Fig. 1
Fig. 1
Anterior corneal image of a patient with dry-eye disease obtained with the spectral domain anterior segment OCT with an ultrahigh resolution of ~3 µm, a as acquired by the OCT, and b after inserting the reference points using the custom-built software in order to obtain the corneal epithelial profile map. The reference points are manually inserted by the user on the anterior (red dots) and posterior (purple dots) surface of the epithelium
Fig. 2
Fig. 2
Anterior corneal image of a control patient obtained with the spectral domain anterior segment OCT with an ultrahigh resolution of ~3 µm, a as acquired by the OCT, and b after inserting the reference points using the custom-built software in order to obtain the corneal epithelial profile maps. The reference points are manually inserted by the user on the anterior (red dots) and posterior (purple dots) surfaces of the epithelium
Fig. 3
Fig. 3
Scatterplot of epithelial irregularity factor (EIF) measurement averaged between eyes versus the result of the Shihpai dry-eye symptom questionnaire score depicting the correlation in the group of patients with dry eye
Fig. 4
Fig. 4
Scatterplots of epithelial irregularity factor (EIF) measurement versus a the result of Corneal Fluorescein Staining score and b the result of Schirmer’s test depicting the correlation of EIF with both parameters
See this image and copyright information in PMC

References

    1. O’Brien PD, Collum LM. Dry eye: diagnosis and current treatment strategies. Curr Allergy Asthma Rep. 2004;4:314–9. doi: 10.1007/s11882-004-0077-2. - DOI - PubMed
    1. Sullivan BD, Whitmer D, Nichols KK, Tomlinson A, Foulks GN, Geerling G, et al. An objective approach to dry eye disease severity. Investig Ophthalmol Vis Sci. 2010;51:6125–30. doi: 10.1167/iovs.10-5390. - DOI - PubMed
    1. Foulks GN. Challenges and pitfalls in clinical trials of treatments for dry eye. Ocul Surf. 2003;1:20–30. doi: 10.1016/S1542-0124(12)70004-6. - DOI - PubMed
    1. Yokoi N, Komuro A. Non-invasive methods of assessing the tear film. Exp Eye Res. 2004;78:399–407. doi: 10.1016/j.exer.2003.09.020. - DOI - PubMed
    1. Pflugfelder SC, Tseng SC, Sanabria O, Kell H, Garcia CG, Felix C, et al. Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea. 1998;17:38–56. doi: 10.1097/00003226-199801000-00007. - DOI - PubMed

Publication types