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KMID : 1159320180200010037
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Korean Journal of Vision Science
2018 Volume.20 No. 1 p.37 ~ p.47
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Development of K-Schirmer Strip and Evaluation of Clinical Availability
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Park Jung-Eun
Kim Yeon-Hee
Jeong Myeong-Jin
Lee Koon-Ja
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Abstract
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Purpose: The purpose of this study was to develop a Schirmer strip for a decrease of irritative and foreign body sensation and evaluate the reliability and clinical usefulness.
Methods: The strip was produced by Whatman paper (#41) with 41 mm in length, 5 mm in with 3 mm of width for insertion area and blue dye was included for easy measuring which is named as K-Schirmer strip. To assess the accuracy of K-Schirmer strip, the strips were evaluated after immersed for 1 minute in a solution of 2-10 μl. The experiment was repeated 10 times. Reliability of repeated measurements were evaluated through clinical tests. To evaluated the sensitivity and the specificity of the examinations, TBUT test was used as diagnostic criteria for dry eye, and the sensitivity and specificity were analyzed by the receiver operating characteristic (ROC) curve. In order to compare and evaluate the K-Schirmer strip, Schirmer tear® (EagleVision Inc., Menphis, TN, USA) on the market was used under the same conditions. The reliability of repeated measurements was evaluated with intraclass correlation coefficients, and ROC curve was analyzed by the statistical program Medcalc version 17.5.5 (Medcalc Software, Mariakerke). The cut-off value was confirmed and the area under the curve (AUC) as an indicator of accuracy was used, and the significance level was p<0.05.
Results: The reliability of both K-Schirmer strip and Schirmer strip were measured as high as 99.9%, and the correlation coefficient of absorbed distance and amount of solution were 0.981 and 0.982, respectively. In clinical tests, the K-Schirmer test value was shorter than the Schirmer test value (p=0.03); however, reliability of repeated measurements was estimated to be 66%, which is higher than that of Schirmer test of 58%, and the degree of irritation with K-Schirmer strip was lower than that of the Schirmer strip(p=0.02). The K-Schirmer and Schirmer test showed high correlation (r=0.59), and the sensitivities and specificities with the K-Schirmer and the Schirmer test for the dry eyes were 40.35%, 79.07%, and 50.88%, 62.79%, respectively.
Conclusion: It is considered that K-Schirmer strip as tear test tool reduces the sense of irritation compared to traditional Schirmer strip.
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KEYWORD
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Schirmer test, K-Schirmer test, Tear test, Tear volume
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