Official ESCRS | European Society of Cataract & Refractive Surgeons


Repeatability of non-invasive tear break-up time measurements obtained with the Sirius eye anterior segment analyser

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Session Details

Session Title: Anterior Segment Imaging

Session Date/Time: Monday 16/09/2019 | 14:00-16:00

Paper Time: 14:06

Venue: Free Paper Forum: Podium 4

First Author: : E.Yassa TURKEY

Co Author(s): :    C. Ünlü   T. Kurt                          

Abstract Details


Classically, clinicians diagnose dry eye disease by obtaining history of the patient and thorough examination of the anterior eye including fluorescein tear break-up time (FBUT) measurement, Shirmer’s test and ocular surface staining. Because of some drawbacks of the FBUT measurements, noninvasive break-up time (NI-BUT) assessment methods were developed recently. The Sirius anterior segment analyser (CSO, Florence, Italy) provides NI-BUT. The repeatability of NI-BUT measurements of the Sirius and agreement of these measurements with FBUT values had not been investigated to date.


Asya Eye Medical Centre, Istanbul,Turkey.


We performed NI-BUT and FBUT measurements on all the patients. NI-BUT was measured using “advanced tear function” mode of a Sirius-running Phoenix software (version which provides first NI-BUT (fNI-BUT) and average NI-BUT (aNI-BUT) values. We calculated repeated measures one-way analysis of variance (ANOVA), intraclass correlation coefficient (ICC), within subject standard deviation (Sw), intrasession test-retest variability, and coefficient of variation (COV) to determine repeatability. Finally, agreement between the tear break up measurement methods was investigated via Bland-Altman analysis.


This prospective study included 103 eyes of 103 subjects (32 males, 71 females) with a mean age of 42.7 years. For the fNI-BUT and aNI-BUT measurements, repeatability was weak with a ICC of less than 0.22. The 95% limits of agreement (LoA) between fNI-BUT and FBUT was from −13.78 seconds to 15.47 seconds and between aNI-BUT and FBUT was from −13.23 seconds to 12.73 seconds. Finally, correlations between fNI-BUT and FBUT (r = 0.25, P = 0.131) and aNI-BUT and FBUT (r = 0.134, P = 0.178) were weak.


NI-BUT measurements of the Sirius device showed low repeatability. The agreement and correlation between the NI-BUT values provided by the Sirius and FBUT values was weak.

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