Lid-parallel conjunctival fold (LIPCOF) morphology imaged by optical coherence tomography and its relationship to LIPCOF grade

Stefan Bandlitz; Christine Purslow; Paul J Murphy; Heiko Pult

doi:10.1016/j.clae.2018.10.025

Lid-parallel conjunctival fold (LIPCOF) morphology imaged by optical coherence tomography and its relationship to LIPCOF grade

Cont Lens Anterior Eye. 2019 Jun;42(3):299-303. doi: 10.1016/j.clae.2018.10.025. Epub 2018 Nov 12.

Authors

Stefan Bandlitz¹, Christine Purslow², Paul J Murphy³, Heiko Pult⁴

Affiliations

¹ Höhere Fachschule für Augenoptik Köln (Cologne School of Optometry), Cologne, Germany; Ophthalmic Research Group, Life and Health Sciences, Aston University, Birmingham, UK. Electronic address: bandlitz@hfak.de.
² School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
³ School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK; University of Waterloo, School of Optometry and Vision Science, Waterloo, Canada.
⁴ Ophthalmic Research Group, Life and Health Sciences, Aston University, Birmingham, UK; School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK; Optometry and Vision Research, Weinheim, Germany.

PMID: 30442513
DOI: 10.1016/j.clae.2018.10.025

Abstract

Purpose: Lid-parallel conjunctival folds (LIPCOF) are a well-accepted clinical sign in dry eye diagnosis. Commonly, LIPCOF is classified by grading the number of folds observed by slit-lamp microscope. This study investigated the relationship between subjective grading scale and LIPCOF morphology imaged by optical coherence tomography (OCT).

Methods: Temporal and nasal LIPCOF of 42 subjects (mean age 27.3 ± 8.4 (SD) years; 13 M, 29 F) were observed and classified by an experienced optometrist using the Pult LIPCOF grading scale (0: no permanent, lid-parallel conjunctival fold; 1: one fold; 2: two folds, 3: three or more folds). Additionally, LIPCOF cross-sectional area (LIPCOF-A) and fold count (LIPCOF-C), as imaged by OCT (Cirrus HD; Carl Zeiss Meditec, Jena, Germany), were analysed with ImageJ 1.50 (http://rsbweb.nih.gov/ij). Correlations between subjective grading and LIPCOF-A and LIPCOF-C were analysed by Spearman correlation, differences between subjective grading and LIPCOF-C were analysed by Wilcoxon test.

Results: For temporal and nasal sectors, mean subjective LIPCOF grade was 1.43 ± 0.86 grade units and 0.57 ± 0.80 grade units, mean LIPCOF-C was 1.67 ± 0.82 folds and 0.69 ± 0.78 folds, and mean LIPCOF-A was 0.0676 ± 0.0236mm² and 0.0389 ± 0.0352 mm², respectively. Subjective temporal and nasal LIPCOF grade was significantly correlated to LIPCOF-C (r = 0.610, p < 0.001 and r = 0.645, p < 0.001, respectively), and to LIPCOF-A (r = 0.612, p < 0.001 and r = 0.583, p < 0.001, respectively). LIPCOF-C was not statistical different to subjective LIPCOF grade (p = 0.07 and p = 0.239; temporal and nasal sectors, respectively).

Conclusions: OCT allows for better imaging of finer details of LIPCOF morphology, and especially of LIPCOF area. OCT evaluation of LIPCOF area correlated well with subjective grading and appears to be a promising objective method for LIPCOF classification.

Keywords: Conjunctivochalasis; LIPCOF; Lid-parallel conjunctival folds; OCT; Optical coherence tomography.

MeSH terms

Adult
Conjunctival Diseases / classification
Conjunctival Diseases / diagnostic imaging*
Dry Eye Syndromes / classification
Dry Eye Syndromes / diagnostic imaging*
Eyelid Diseases / classification
Eyelid Diseases / diagnostic imaging*
Female
Humans
Male
Slit Lamp Microscopy
Surveys and Questionnaires
Tomography, Optical Coherence
Young Adult