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Br J Ophthalmol. 2018 Dec;102(12):1615-1620. doi: 10.1136/bjophthalmol-2018-312333. Epub 2018 Jun 15.

Effects of tear film dynamics on quality of vision.

Author information

Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan.
Division of Surgery, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Inoue Eye Clinic, Okayama, Japan.
Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China.
Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.


The precorneal tear film is maintained by blinking and exhibits different phases in the tear cycle. The tear film serves as the most anterior surface of the eye and plays an important role as a first refractive component of the eye. Alterations in tear film dynamics may cause both vision-related and ocular surface-related symptoms. Although the optical quality associated with the tear film dynamics previously received little attention, objective measurements of optical quality using wavefront sensors have enabled us to quantify optical aberrations induced by the tear film. This has provided an objective method for assessing reduced optical quality in dry eye; thus, visual disturbances were included in the definition of dry eye disease in the 2007 Dry Eye Workshop report. In addition, sequential measurements of wavefront aberrations have provided us with valuable insights into the dynamic optical changes associated with tear film dynamics. This review will focus on the current knowledge of the mechanisms of wavefront variations that are caused by different aspects of tear film dynamics: specifically, quality, quantity and properties of the tear film, demonstrating the respective effects of dry eye, epiphora and instillation of eye drops on the quality of vision.


optics and refraction; tears

Conflict of interest statement

Competing interests: None declared.

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