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Sci Rep. 2018 Sep 7;8(1):13443. doi: 10.1038/s41598-018-31814-7.

Maximum blink interval is associated with tear film breakup time: A new simple, screening test for dry eye disease.

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Juntendo University Faculty of Medicine, Department of Ophthalmology, Tokyo, Japan.
Juntendo University Faculty of Medicine, Department of Strategic Operating Room Management and Improvement, Tokyo, Japan.
London School of Hygiene and Tropical Medicine, Department of Non-Communicable Disease Epidemiology, London, UK.
Juntendo University Faculty of Medicine, Department of Ophthalmology, Tokyo, Japan.
University of Massachusetts Medical School, Worcester, MA, USA.


The prevalence of dry eye disease (DED) is increasing worldwide, and its diagnosis often needs dedicated reagents and machines. We investigated the usefulness of maximum blink interval (MBI) (the length of time that participants could keep their eyes open) in screening for DED. This cross-sectional study included 292 patients (194 with DED and 98 without DED) recruited between September 2016 and September 2017. We compared the MBI between patients with and without DED; examined correlations between MBI and other clinical features of DED, including subjective symptoms (Dry Eye-Related Quality-of-Life Score), tear film breakup time (TFBUT), cornea fluorescence score (CFS), and Schirmer test I value; and determined the optimal cutoff value of MBI to suspect DED using a receiver operating characteristic (ROC) analysis. The MBI was significantly shortened in DED group compared to the non-DED group (10.0 ± 9.1 vs. 24.3 ± 38.2 seconds, p < 0.001). TFBUT was strongly positively correlated with MBI (r = 0.464), whereas CFS was negatively correlated with MBI (r = -0.273). The area under the ROC curve was 0.677, and the optimal MBI cutoff value was 12.4 seconds, providing a sensitivity of 82.5% and specificity of 51.0% to suspect DED. In conclusion, MBI may be a simple, useful test for screening DED.

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