Impact of Improper Approach to Identify Lid Wiper Epitheliopathy (LWE)

Christopher W Lievens,1 Yvonne Norgett,2 Nancy Briggs,3 Peter M Allen,4 Marta Vianya-Estopa2 1The Eye Center, Southern College of Optometry, Memphis, TN, USA; 2Department of Vision & Hearing Sciences, Anglia Ruskin University, Cambridge, UK; 3Mark Wainwright Analytical Centre, University New...

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Autores principales:	Lievens CW, Norgett Y, Briggs N, Allen PM, Vianya-Estopa M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	lid wiper epitheliopathy dry eye lissamine green sodium fluorescein false negative Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/452c6755d1a247c68e2a9dd7b3eaceb2
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spelling	oai:doaj.org-article:452c6755d1a247c68e2a9dd7b3eaceb22021-12-02T10:37:34ZImpact of Improper Approach to Identify Lid Wiper Epitheliopathy (LWE)1177-5483https://doaj.org/article/452c6755d1a247c68e2a9dd7b3eaceb22020-10-01T00:00:00Zhttps://www.dovepress.com/impact-of-improper-approach-to-identify-lid-wiper-epitheliopathy-lwe-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Christopher W Lievens,1 Yvonne Norgett,2 Nancy Briggs,3 Peter M Allen,4 Marta Vianya-Estopa2 1The Eye Center, Southern College of Optometry, Memphis, TN, USA; 2Department of Vision & Hearing Sciences, Anglia Ruskin University, Cambridge, UK; 3Mark Wainwright Analytical Centre, University New South Wales, Sydney, Australia; 4Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UKCorrespondence: Christopher W LievensThe Eye Center, Southern College of Optometry, 1245 Madison Avenue, Memphis, TN 38104, USATel +1 901 722 3330Fax +1 901 722 3280Email clievens@sco.eduPurpose: Variability in the use of ophthalmic dyes to diagnose lid wiper epitheliopathy (LWE) has led to division in the literature and clinical practice. The principal aim of this study was to evaluate whether the use of a non-optimal methodology to identify LWE had a potential for false negatives; in which LWE was overlooked.Patients and Methods: A total of 20 participants were initially categorized to not have LWE and were enrolled in this study. The protocol examined whether or not LWE would later be revealed through the use of optimized methodology. Semi-automated analysis was performed of images taken after two different drop instillations with varying post-dye viewing times for both lissamine green (LG) and sodium fluorescein (NaFl).Results: There was a significant increase in area of staining revealed when an optimal methodology for LWE identification was used. Comparisons for every non-optimal condition were statistically significantly different against the optimal condition (all p< 0.01). The use of a non-optimal methodology resulted in a 70% false-negative rate when using LG and a 95% false-negative rate when using NaFl.Conclusion: The study demonstrated that using a double instillation of dye was statistically different from a single-dose, even with extended wait time for clinical observation. A single instillation did not offer adequate volume of dye for adequate lid margin uptake. A careful adherence to volume as well as a repeat administration is key to revealing the full area of LWE. A non-optimal approach to diagnose LWE can lead to false negatives.Keywords: lid wiper, epitheliopathy, dry eye, lissamine green, sodium fluorescein, false negativeLievens CWNorgett YBriggs NAllen PMVianya-Estopa MDove Medical Pressarticlelid wiperepitheliopathydry eyelissamine greensodium fluoresceinfalse negativeOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 3039-3047 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	lid wiper epitheliopathy dry eye lissamine green sodium fluorescein false negative Ophthalmology RE1-994
spellingShingle	lid wiper epitheliopathy dry eye lissamine green sodium fluorescein false negative Ophthalmology RE1-994 Lievens CW Norgett Y Briggs N Allen PM Vianya-Estopa M Impact of Improper Approach to Identify Lid Wiper Epitheliopathy (LWE)
description	Christopher W Lievens,1 Yvonne Norgett,2 Nancy Briggs,3 Peter M Allen,4 Marta Vianya-Estopa2 1The Eye Center, Southern College of Optometry, Memphis, TN, USA; 2Department of Vision & Hearing Sciences, Anglia Ruskin University, Cambridge, UK; 3Mark Wainwright Analytical Centre, University New South Wales, Sydney, Australia; 4Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UKCorrespondence: Christopher W LievensThe Eye Center, Southern College of Optometry, 1245 Madison Avenue, Memphis, TN 38104, USATel +1 901 722 3330Fax +1 901 722 3280Email clievens@sco.eduPurpose: Variability in the use of ophthalmic dyes to diagnose lid wiper epitheliopathy (LWE) has led to division in the literature and clinical practice. The principal aim of this study was to evaluate whether the use of a non-optimal methodology to identify LWE had a potential for false negatives; in which LWE was overlooked.Patients and Methods: A total of 20 participants were initially categorized to not have LWE and were enrolled in this study. The protocol examined whether or not LWE would later be revealed through the use of optimized methodology. Semi-automated analysis was performed of images taken after two different drop instillations with varying post-dye viewing times for both lissamine green (LG) and sodium fluorescein (NaFl).Results: There was a significant increase in area of staining revealed when an optimal methodology for LWE identification was used. Comparisons for every non-optimal condition were statistically significantly different against the optimal condition (all p< 0.01). The use of a non-optimal methodology resulted in a 70% false-negative rate when using LG and a 95% false-negative rate when using NaFl.Conclusion: The study demonstrated that using a double instillation of dye was statistically different from a single-dose, even with extended wait time for clinical observation. A single instillation did not offer adequate volume of dye for adequate lid margin uptake. A careful adherence to volume as well as a repeat administration is key to revealing the full area of LWE. A non-optimal approach to diagnose LWE can lead to false negatives.Keywords: lid wiper, epitheliopathy, dry eye, lissamine green, sodium fluorescein, false negative
format	article
author	Lievens CW Norgett Y Briggs N Allen PM Vianya-Estopa M
author_facet	Lievens CW Norgett Y Briggs N Allen PM Vianya-Estopa M
author_sort	Lievens CW
title	Impact of Improper Approach to Identify Lid Wiper Epitheliopathy (LWE)
title_short	Impact of Improper Approach to Identify Lid Wiper Epitheliopathy (LWE)
title_full	Impact of Improper Approach to Identify Lid Wiper Epitheliopathy (LWE)
title_fullStr	Impact of Improper Approach to Identify Lid Wiper Epitheliopathy (LWE)
title_full_unstemmed	Impact of Improper Approach to Identify Lid Wiper Epitheliopathy (LWE)
title_sort	impact of improper approach to identify lid wiper epitheliopathy (lwe)
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/452c6755d1a247c68e2a9dd7b3eaceb2
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Impact of Improper Approach to Identify Lid Wiper Epitheliopathy (LWE)

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