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Purpose: To evaluate the efficacy of a recently proposed method forcharacterizing tear film dynamics using non-invasive high speedvideokeratoscopy in assessing the loss of homeostasis of tear film. Methods:Thirty subjects, from a retrospective study, of which 11 were classified as dryeye and 19 as normal, were included. High speed videokeratoscopy measurementswere performed using E300 videokeratoscope (Medmont Pty., Ltd, Melbourne,Australia). Raw data was analyzed using a recently proposed method to estimatethe dynamics of the tear film, based on a fractal dimension approach. Thismethod provides three time-varying indicators related to the regularity of thereflected rings: Tear Film Surface Quality (TFSQ) indicator, Breaks FeatureIndicator (BFI) and Distortions Feature Indicator (DFI). From each indicatorfive parameters were extracted and analyzed, including non-invasive break uptime, mean value of the indicator in the stability phase, mean value of theindicator in the whole inter blink interval, mean value of the indicator in thelevelling phase and the general trend of the time series. Receiver OperatingCharacteristic were used to determine the sensitivity and specificity of eachparameter in dry eye detection. Results: The best discrimination performancebetween dry eye and normal subjects was achieved with the BFI non-invasivebreak up time parameter, with an area under the curve of 0.85. For a cut offvalue of 10 s the sensitivity was 100% and the specificity 84%. Conclusions:The analyzed method improves the assessment of tear film homeostasis incomparison to previous high speed videokeratoscopy methods showing higherpotential in assisting dry eye diagnosis.

Supporting dry eye diagnosis with a new method for non-invasive tear film quality assessment