Comparison of strip meniscometry and Schirmer tear test results and tear film breakup time between healthy dogs and dogs with dry eye disease

Nascimento, Felipe Franco; Passareli, João Victor Goulart Consoni; Zulim, Luís Felipe da Costa; Silva, Danielle Alves; Giuffrida, Rogerio; Estanho, Giovana José Garcia; Villa, Mayra Claudino; Andrade, Silvia Franco

doi:10.5935/0004-2749.20230057

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ORIGINAL ARTICLE • Arq. Bras. Oftalmol. 86 (4) • Jul-Aug 2023 • https://doi.org/10.5935/0004-2749.20230057 copy

Comparison of strip meniscometry and Schirmer tear test results and tear film breakup time between healthy dogs and dogs with dry eye disease

Comparação entre o teste de meniscometria em tira, o teste lacrimal de Schirmer e o tempo de ruptura do filme lacrimal em cães normais e com olho seco

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

To compare strip meniscometry and Schirmer tear test 1 results and tear film breakup time between dogs with normal eyes and dogs diagnosed with keratoconjunctivitis sicca. Methods: One-hundred fifty-six eyes of 78 dogs, 88 normal eyes, and 68 eyes diagnosed with keratoconjunctivitis sicca were included in the study. The tests were performed in the following sequence: Schirmer tear test 1 was used to allocate the dogs to the normal or keratoconjunctivitis sicca group, followed by the strip meniscometry test and tear film breakup time measurement.

Results:

The results (mean ± standard deviation) of the tests in the normal group were as follows: Schirmer tear test 1, 22.75 ± 3.88 mm/min; strip meniscometry test, 10.01 ± 2.35 mm/5 sec; and tear film breakup time, 25.82 ± 5.47 sec. In the keratoconjunctivitis sicca group, the results were as follows: Schirmer tear test 1, 6.10 ± 4.44 mm/min; strip meniscometry test, 3.03 ± 2.62 mm/5 sec; and tear film breakup time, 10.78 ± 4.23 sec. The Spearman correlation coefficient in the keratoconjunctivitis sicca group was very high, with a significant difference between the strip meniscometry test and Schirmer tear test 1 (r=0.848, p<0.001), and moderate and significant between the strip meniscometry test and tear film breakup time (r=0.773, p<0.001). The cutoff for the strip meniscometry test for keratoconjunctivitis sicca was 7.0 mm/5 sec. Keratoconjunctivitis sicca was suspected when the values were <10 mm/5 sec.

Conclusions:

This study provided strip meniscometry test values from dogs with normal eyes and eyes with keratoconjunctivitis sicca, with high sensitivity and specificity compared with those of the Schirmer tear test 1. In the future, the strip meniscometry test may be another important quantitative test and could complement the gold standard Schirmer tear test for the diagnosis of keratoconjunctivitis sicca in dogs, an excellent animal model for the study of the disease.

Keywords:
Keratoconjunctivitis sicca; Schirmer tear test; Strip meniscometry test; Tear film breakup time; Dogs

Group	Sex n(%)	Age mean ± standard deviation (range values)	Breed
Normal(STT ≥5) n=44	33 males (75) 11 females (25)	3.0±1.6(1-6)	French bulldog (15); mixed breed (13); Lhasa Apso (4); English bulldog (3); Shih-tzu (2); Yorkshire Terrier (2); Boxer (1); Campero bulldog (1); Chihuahua (1); Cocker Spaniel (1); and Maltese (1)
KCS Severe(STT 0-5) n=16	6 males (37,5) 10 females (62,5)	9.1±3.5^* * p<0.05 (Tukey test to compare age with the normal group). (4-16)	Poodle (3); Lhasa Apso (3); Yorkshire Terrier (2); Cocker Spaniel (2); Shih-tzu (1); Pinscher (2); Pekinese (1); Chow Chow (1); and mixed breed (1)
KCS Moderate(STT 6-10) n=11	2 males (18,2) 9 females (81,8)	7.8±2.7^* * p<0.05 (Tukey test to compare age with the normal group). (4-12)	Shih-tzu (4); Poodle (3); English Bulldog (2); Lhasa Apso (1); and Yorkshire Terrier (1)
KCS Subclinical (STT 11-14) n=7	4 males (57,1) 3 females (42,9)	5.1±2.6 (0,5-8)	Miniature Schnauzer (2); mixed breed (2); Lhasa Apso (1); Maltese (1); and Rottweiler (1)

Tests	Total eyes (n=156)	STT classified (mm/min)
Tests	Total eyes (n=156)	Normal (≥15) n=88	KCS severe (0-5) n=32	KCS moderate (6-10) n=22	KCS subclinical (11-14) n=14	KCS total (≤14) n=68
STT-1 (mm/min)
Mean ± SD	15.49 ± 9.25	22.75 ± 3.88 (a)	2.21 ± 2.03 (b)	8.27 ± 1.52 (c)	12.62 ± 0.96 (d)	6.10 ± 4.44
Median	18	23	2	9	13	6
Range	0-30	15-30	0-5	6-11	11-14	0-14
SMT (mm/5 sec)
Mean ± SD	6.97 ± 4.26	10.01 ± 2.35 (a)	1.21 ± 1.71 (b)	4.40 ± 1.97 (b)	5.60 ± 2.40 (c)	3.03 ± 2.62
Median	8	9	0	5	5	3
Range	0-19	8-19	0-8	0-8	2-10	0-10
TBUT (sec)
Mean ± SD	19.26 ± 8.97	25.82 ± 5.47 (a)	8.21 ± 3.30 (b)	12.32 ± 3.12 (b)	15.46 ± 2.82 (c)	10.78 ± 4.23
Median	20	24	9	13	16	11
Range	3-44	20-44	3-15	5-16	9-19	3-19

STT1-classified^* * STT-1 classification: normal healthy eyes, STT-1 ≥15 mm/min; severe KCS, 0-5mm/min; moderate KCS (6-10 mm/min); and subclinical KCS, 11-14 mm/min.	Correlation	ρ^ Spearman correlation coefficient; 95% CI, estimation of r through an interval with 95% confidence.	95% CI	p value^ Spearman correlation coefficient; 95% CI, estimation of r through an interval with 95% confidence. ^* * STT-1 classification: normal healthy eyes, STT-1 ≥15 mm/min; severe KCS, 0-5mm/min; moderate KCS (6-10 mm/min); and subclinical KCS, 11-14 mm/min.
Normal	STT-1 x SMT	0.146	-0.065 to 0.345	0.173
	STT-1 x TBUT	0.228	0.020 to 0.418	0.032
	SMT x TBUT	0.043	-0.168 to 0.250	0.690
0-5	STT-1 x SMT	0.681	0.440 to 0.830	<0.0001
	STT-1 x TBUT	0.353	0.011 to 0.621	0.043
	SMT x TBUT	0.430	0.101 to 0.673	0.012
6-10	STT-1 x SMT	0.480	0.076 to 0.751	0.023
	STT-1 x TBUT	0.061	-0.370 to 0.470	0.786
	SMT x TBUT	0.440	0.022 to 0.726	0.040
11-14	STT-1 x SMT	0.183	-0.408 to 0.667	0.548
	STT-1 ´ TBUT	0.317	-0.283 to 0.740	0.290
	SMT x TBUT	0.460	-0.121 to 0.806	0.113
KCS total	STT-1 x SMT	0.848	0.700 to 0.887	<0.0001
	STT-1 x TBUT	0.846	0.794 to 0.885	<0.0001
	SMT x TBUT	0.773	0.701 to 0.830	<0.0001

SMT cutoff (mm/5 sec)	STT-1 criterion
	5 mm/min			10 mm/min			15 mm/min
	Sensitivity	Specificity	J	Sensi-tivity	Specificity	J	Sensitivity	Specificity	J
<1	0.98	0.64	0.62	1.00	0.42	0.42	1.00	0.32	0.32
<2	0.97	0.79	0.76	0.99	0.53	0.52	1.00	0.42	0.42
<3	0.93	0.97	0.90	0.98	0.71	0.69	1.00	0.58	0.58
<4	0.86	0.97	0.83	0.94	0.78	0.72	1.00	0.69	0.69
<5	0.80	0.97	0.77	0.93	0.89	0.82	1.00	0.79	0.79
<6	0.76	0.97	0.73	0.92	0.96	0.88	1.00	0.86	0.86
<7	0.76	0.97	0.73	0.91	0.96	0.87	1.00	0.87	0.87
<8	0.54	1.00	0.54	0.65	1.00	0.65	0.75	0.97	0.72
<9	0.29	1.00	0.29	0.36	1.00	0.36	0.41	0.99	0.40
<10	0.17	1.00	0.17	0.21	1.00	0.21	0.25	1.00	0.25
<11	0.16	1.00	0.16	0.20	1.00	0.20	0.24	1.00	0.24
<12	0.12	1.00	0.12	0.15	1.00	0.15	0.18	1.00	0.18
<13	0.07	1.00	0.07	0.09	1.00	0.09	0.11	1.00	0.11
<14	0.04	1.00	0.04	0.05	1.00	0.05	0.06	1.00	0.06
<15	0.02	1.00	0.02	0.02	1.00	0.02	0.02	1.00	0.02
<16	0.02	1.00	0.02	0.02	1.00	0.02	0.02	1.00	0.02
<17	0.02	1.00	0.02	0.02	1.00	0.02	0.02	1.00	0.02
<18	0.01	1.00	0.01	0.01	1.00	0.01	0.01	1.00	0.01
<19	0.00	1.00	0.00	0.00	1.00	0.00	0.00	1.00	0.00
<20	0.00	1.00	0.00	0.00	1.00	0.00	0.00	1.00	0.00

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[1] Corresponding author: Silvia Franco Andrade. E-mail: silviafranco@unoeste.br