목 적 : 침습성 눈물막파괴시간(TBUT, invasive tear break-up time)과 비침습성 눈물막파괴시간 (NIBUT, noninvasive tear break-up time) 검사법의 정확도를 비교하고자 하였다. 방 법 : 안질환이 없으며 굴절교정수술을 받지 않은 20대 대학생 56명(112안)을 대상으로 TBUT는 Fluorescein strip을 사용하여 측정하였고, NIBUT는 Keratograph 5M(K5M), Wavefront Analyzer (KR-1W), Auto refractor keratometer(KR-8100P)을 사용하여 측정하였다. 건성안 감별(screening) 기준 은 OSDI(ocular surface disease index) 설문지를 사용하였다. 각 측정값의 일치도 분석은 Bland & Altman Plot을 사용하여 확인하였고, 검사값의 정확도는 ROC(receiver operating characteristic) curve를 이용하여 민감도(sensitivity) 및 특이도(specificity), AUC(area under the curve), cut-off 값을 비교하여 분석하였다. 결 과 : TBUT는 NIBUT보다 유의하게 짧았고(p<0.05), KR-1W, KR-8100P, K5M으로 측정한 NIBUT 값들은 서로 유의한 차이가 없었다(F=2.69, p=0.06). NIBUT 검사값은 서로 중등도의 상관성을 보였지만 (r=0.36,0.44,0.35), TBUT는 K5M로 측정한 NIBUT와 상관성이 있었다. 검사법 상호간의 일치도 분석에서 TBUT와 NIBUT는 차이가 있었고, NIBUT 값들은 상호간 차이가 없었다. 건성안 유무 감별에 대한 민감도와 특이도는 각각 TBUT 검사법에서 25%, 80%, KR-1W 검사법에서 50%, 69%, KR-8100P 검사법에서 86%, 34%, K5M 검사법에서 31%, 82%로, 민감도는 KR-8100P 검사법이 가장 높았고, 특이도는 K5M 검사법이 가장 높았다. 결 론 : NIBUT 검사법은 TBUT 검사법보다 정확도가 높고, 검사법 상호간의 일치도가 우수하며, 건성안 감별에 KR-8100P 측정값이 유용하게 사용될 수 있을 것으로 사료된다.

Purpose: To compare the accuracy of invasive and non-invasive tear breakup time methods Methods: Tear breakup time (TBUT) was measured by using a fluorescein strip (Haag-Streit Strips, Haag-Streit, USA) and non-invasive tear break up time (NIBUT) was measured by using Keratograph 5M (K5M), Wavefront Analyzer (KR-1W), and Auto refraction keratometry (KR-8100P) for the 56 university students (112 eyes) who neither had eye disease nor had undergone refractive surgery. For the dry eyes screening, OSDI (Ocular Surface Disease Index) questionnaire was used. Agreement between tear break up methods was analyzed by using Bland & Altman Plot. Sensitivity, specificity and area under the curve (AUC) and cut-off value were analyzed by using receiver operating characteristic (ROC) curve Results: TBUT was significantly shorter than NIBUT (P<0.05) and NIBUTs measured by KR-1W, KR-8100P, K5M were not significantly different (F=2.69, P=0.06). NIBUTs were shown moderate correlation among them(r=0.36, r=0.44, r=0.35), however TBUT were shown correlation only with NIBUT measured by K5M. In the agreements analysis, there was no difference among NIBUTs, however TBUT and NIBUTs were shown significantly different. Sensitivities and specificities for the dry eye screening of the TBUT and NIBUTs measured by KR-1W, KR-8100P and K5M method were 25% and 80%, 50% and 69%, and 86% and 34%, 31% and 82%, respectively. The sensitivity of KR-8100P measurements was the highest and the specificity of K5M measurements was the highest. Conclusion: NIBUT was more accuracy than TBUT and agreement of measurements among NIBUTs was good, and among the NIBUT measurements the KR-8100P measurements showed high accuaracy that it could be useful for dry eye screening.

• Yun-Jung Lee(을지대학교 보건대학원 안경광학과) | 이윤정
• Jeong-Mee Kim(을지대학교 안경광학과) | 김정미
• Koon-Ja Lee(을지대학교 보건대학원 안경광학과, 을지대학교 안경광학과) | 이군자 Corresponding author