Objective: To study the sensitivity and specificity of tear film objective scatter index to the diagnosis dry eye disease (DED). Methods: A prospective case-controlled study. Fifty-three patients with DED and 32 healthy age- and sex-matched control subjects were included from July to October 2016. All subjects underwent the examinations sequentially as follows: evaluation of ocular surface disease symptoms using the Ocular Surface Disease Index, optical quality detection, lipid layer thickness, tear film breakup time and SchirmerⅠtest. With Optical Quality Analysis SystemⅡ, the values of modulation transfer function cut off, basic objective scatter index (OSI) and total OSI were measured. To eliminate the influence of other refractive media, the tear film OSI (TF-OSI) was calculated, and the difference in TF-OSI between two groups was analyzed with the independent-samples t test. Spearman's correlation analysis was used to detect the correlation of each parameter in the DED group. With the receiver operating characteristic curve and the area under the curve (AUC), the specificity and sensitivity of TF-OSI and other parameters were described to differentiate DED from normal eyes. Results: In the dry eye group, the value of modulation transfer function cut off (32.07±11.95) was significantly lower than the normal group (39.38±9.44, t=-3.096, P=0.003) , and the mean value and dispersion of TF-OSI (0.50±0.43, 0.52±0.81) were higher than the normal group (0.21±0.16, 0.12±0.01) (t=4.300, P=0.000, t=3.546, P=0.001) . The mean value of TF-OSI had a positive correlation with lipid layer thickness (r=0.365, P=0.007) and dispersion of TF-OSI (r=0.581, P=0.000), and a negative correlation with MTF cut off (r=-0.368, P=0.007). To the diagnostic value of DED, the mean value of TF-OSI had a sensitivity of 0.736, a specificity of 0.762, and the AUC was 0.764. The dispersion of TF-OSI had a sensitivity of 0.811 and a specificity of 0.810, and the AUC was 0.900. Conclusion: In the DED group, the mean value and dispersion of TF-OSI were higher than the normal group. With its advantages, the TF-OSI may be a new method for the auxiliary diagnosis of dry eye. (Chin J Ophthalmol, 2017, 53: 668-674).
目的： 探讨泪膜客观散射指数在干眼诊断中的意义。 方法： 前瞻性病例对照研究。选取2016年7至10月在北京同仁眼科中心就诊的干眼患者53例（53只眼）作为干眼组，其中男性18例，女性35例；平均年龄（37.3±7.2）岁。选取健康志愿者32名（32只眼）作为对照，其中男性10名，女性22名；平均年龄（38.1±13.8）岁。所有被检查者均按如下顺序进行检查：（1）眼表疾病评分指数（OSDI）问卷调查；（2）视觉质量检测；（3）泪膜脂质层厚度测量；（4）泪膜破裂时间测定；（5）SchirmerⅠ检测。视觉质量使用双通道视觉质量分析系统Ⅱ（OQASⅡ）检测，获取调制传递函数（MTF）截止频率、基础客观散射指数及总客观散射指数值，通过计算得出泪膜客观散射指数（TF-OSI），并对比两组受试者TF-OSI之间的差异，明确TF-OSI与其他干眼客观指标间的相关性，并通过受试者工作特征曲线（ROC曲线）研究该参数对于干眼诊断的敏感性和特异性。两组数据比较采用独立样本t检验，性别差异使用卡方检验；干眼组中各项参数间相关性分析使用Spearman相关分析法。 结果： 干眼组MTF截止频率（32.07±11.95）明显低于对照组（39.38±9.44）（t=-3.096，P=0.003）；TF-OSI平均值（0.50±0.43）明显高于对照组（0.21±0.16）（t=4.300，P=0.000），干眼患者TF-OSI离散度（0.52±0.81）明显高于对照组（0.12±0.06）（t=3.546，P=0.001）。TF-OSI平均值与泪膜脂质层厚度呈正相关（r=0.365，P=0.007），与MTF截止频率呈负相关（r=-0.368，P=0.007），与TF-OSI离散度呈正相关（r=0.581，P=0.000）。TF-OSI对干眼诊断价值：TF-OSI平均值诊断干眼的敏感性为0.736，特异性为0.762，曲线下面积为0.764；TF-OSI标准差诊断干眼的敏感性为0.811，特异性为0.810，曲线下面积为0.900。 结论： 干眼患者泪膜客观散射指数平均值和离散度均增加，该参数凭其特有的优势可成为辅助诊断干眼的新方法。（中华眼科杂志，2017，53：668-674）.
Keywords: Diagnostic imaging; Dry eye syndromes; Light; Scattering, radiation; Sensitivity and specificity; Severity of illness index; Tears.