Heliyon (Jul 2024)
Measurement of lacrimal gland tissue stiffness for the diagnosis of visual display terminal-associated dry eye disease using shear wave elastography
Abstract
Objective: This study aimed to evaluate whether lacrimal gland tissue stiffness can aid in diagnosing dry eye disease (DED) using shear wave elastography (SWE). We also aimed to assess the correlation between the subjective symptoms of ocular strain, SWE values, and other ocular examination findings (Schirmer's test and tear film breakup time [TBUT]) contributing to the diagnosis of DED. Methods: This cross-sectional study recruited 300 participants who were engaged in video display terminal (VDT) work and had been diagnosed with DED by an ophthalmologist for more than one year, and 100 healthy participants without DED symptoms, from August 2020 to December 2021. The modified TFOS DEWS II was used for diagnosing DED. The ocular symptoms, Schirmer's test results, and TBUT of the participants were assessed using standardized methods. Eighty patients with DED and 40 sex- and age-matched healthy participants were selected as the observation and control group, respectively. The lacrimal gland tissue architecture was assessed using ultrasound. Result: The SWE Emean value reflecting the lacrimal gland tissue stiffness of patients with DED was significantly higher than that of healthy participants (11.06 ± 1.26 for the DED group vs. 7.54 ± 1.27 for the control group, P < 0.001). In patients with DED, the Emean values of the lacrimal glands significantly correlated with the scores for subjective symptoms of ocular dryness (P < 0.001). No significant correlation was observed between the TBUT and Schirmer's test results. The area under the receiver operating characteristic (ROC) curve for SWE was 0.995. According to the ROC analysis results using an Emean cutoff value of 9.32 kPa for the diagnosis of DED, the sensitivity, specificity, positive predictive value（PPV）, and negative predictive （NPV）value were 97.5 %, 95 %, 100 %, and 95 %, respectively. Thus, SWE can be considered for diagnosing VDT-associated DED. Conclusion: VDT-associated DED was associated with increased tear gland tissue stiffness. SWE aids in the quantitative detection of lacrimal gland tissue stiffness. Moreover, SWE significantly correlated with the subjective symptoms of DED.
