A new method for tear film stability analysis using videokeratography

Tomoko Goto, Xiaodong Zheng, Stephen D. Klyce, Hisashi Kataoka, Toshihiko Uno, Mike Karon, Yoshiyuki Tatematsu, Takeo Bessyo, Kazuo Tsubota, Yuichi Ohashi

Research output: Contribution to journalArticlepeer-review

118 Scopus citations


PURPOSE: To report a new tear film stability analysis system using videokeratography. DESIGN: Observational case series. METHODS: New videokeratography software for TMS-2N (topographic modeling system; TOMEY Corporation, Nagoya, Japan) was developed that can automatically capture consecutive corneal surface images every second for 10 seconds. Forty-eight adult volunteers (80 eyes) were recruited for this study, and all subjects were examined with the new system. Corneal topographs were analyzed for tear breakup time (TMS-BUT) and the ratio of breakup area to entire color-code area (TMS-BUA) was calculated. Routine methods for tear film breakup time evaluation using slit-lamp microscope and fluorescence staining (SLE-BUT) were performed for comparison purposes. Regressive correlations of TMS-BUT or TMS-BUA with SLE-BUT were analyzed. Based on SLE results, subjects were separated into two groups with normal and short BUT, respectively. TMS-BUT and TMS-BUA were compared with SLE-BUT data with regard to the sensitivity and specificity of evaluation of dry eye symptoms. RESULTS: Topographic modeling system-tear breakup time (TMS-BUT) had a positive correlation with SLE-BUT (R = 0.7219, P < .0001), whereas TMS-BUA showed a negative correlation (R = 0.6317, P < .0001). Among 34 eyes with normal SLE-BUT, 11 eyes (32.35%) displayed abnormal TMS-BUT, 9 (81.82%) of which were associated with dry eye symptoms. The sensitivities of TMS-BUT and TMS-BUA were 97.5% and 95%, respectively, significantly higher than that of SLE-BUT (75%), with P = .008 and 0.01, respectively. Topographic modeling system-BUT and TMS-BUA displayed a similar rate of specificity in comparison with SLE-BUT. CONCLUSIONS: This new videokeratography system is a noninvasive and objective method with increased sensitivity for tear film stability analysis.

Original languageEnglish
Pages (from-to)607-612
Number of pages6
JournalAmerican Journal of Ophthalmology
Issue number5
StatePublished - 1 May 2003
Externally publishedYes


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