Interobserver Reliability of Tear Break-Up Time Examination Using “Smart Eye Camera” in Indonesian Remote Area

Abstract

Introduction

Dry eye disease (DED) is a multifactorial disease of tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability leading to decrease of vision, productivity and quality of life, and blindness. DED diagnosis remains difficult and underdiagnosed regarding inconsistency between subjective symptoms and clinical findings. Tear break-up time (TBUT) is an objective indicator of tear film stability in diagnostic DED. A novel smartphone attachment, namely SEC (smart eye camera), could mimic conventional slit lamp to assess TBUT and beneficial in facilitating DED diagnosis. Reliability between a non and an ophthalmologist in TBUT assessment and DED diagnosis is observed in this study.

Purpose

To determine interobserver reliability of TBUT measurement for diagnosing DED using SEC.

Design

This a cross-sectional analytic study involving 99 participants (198 eyes) aged 40 years who visited Pratama Gema Santi Hospital, Nusa Penida, from September 2nd to 4th, 2022, with consecutive sampling technique.

Methods

Fluoresceined eyes were filmed using the SEC device and apps, continued by masked ophthalmologist and resident assessing TBUT based on the video. The primary outcome is interobserver reliability for TBUT measurement and DED diagnosis.

Results

The mean age of participants was 55.22±9.78 years, 48.5% male and 51.5% female. The reliability of interobserver in assessing DED based on TBUT test is 0.78 (95% CI=0.31–1.26, P-value=0.001), and interobserver reliability in diagnosing DED based on OSDI and TBUT showed good agreement (weighted kappa=0.71). Good interobserver reliability underscores that non-ophthalmologists can diagnose DED based on TBUT video using SEC.

Conclusion

SEC video has good interobserver reliability to assess TBUT for DED diagnosis. SEC can be used as one of the methods in assessing DED in limited health care facilities. The high reliability of interobserver assessment indicates that DED diagnosis using video taken with SEC may be useful for telemedicine evaluation in remote areas.

Graphical Abstract

Keywords:

• dry eye disease
• smart eye camera
• telemedicine

Abbreviations

DED, dry eye disease; TBUT, tear break-up time; SEC, smart eye camera; OSDI, Ocular Surface Disease Index; LoA, limit of agreement; et al, et alia.

Acknowledgment

On this occasion, the author expresses her gratitude to all parties who have helped to carry out the research up to this stage for their helpful and prompt response to requests for their technical help, opinion, and advice. This research was funded by Udayana University Research Grant of International Collaboration.

Disclosure

Dr Ariesanti Tri Handayani reports a patent SEC-i07 pending to Oui. Inc. Dr Eisuke Shimizu reports intellectual property with OUI Inc. All authors report no other conflicts of interest in this study.