Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)最新文献

{"title":"Effect of Lens Shape and Thickness on the Accommodative Range in Adults Aged 40-50 Years.","authors":"Evelien Janssen, Sarah Hershko, Barbara K Pierscionek, Carina Koppen, Jos J Rozema","doi":"10.1007/s44402-026-00206-0","DOIUrl":"https://doi.org/10.1007/s44402-026-00206-0","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the influence of lens shape on accommodative range in individuals aged 40-50 years, a period during which accommodative loss becomes clinically relevant.</p><p><strong>Methods: </strong>Accommodation was measured in 40 participants aged 40-50 years using the RAF Convergence Rule and the Negative Lens Test. Crystalline lens geometry and power, as well as corneal power, axial length and anterior chamber depth, were assessed under cycloplegia using an autorefractor, Pentacam, Lenstar and Casia II OCT. Associations between accommodative range and lenticular parameters were analysed through correlation analysis, with and without corrections for age, sex and refractive error.</p><p><strong>Results: </strong>No significant correlation was observed between the lenticular dimensions and the accommodative range. The change in accommodative amplitude with age was correlated with corneal power and axial length. After correcting for sex and age, these latter two correlations were no longer significant. An additional correction for the spherical equivalent refractive error did not change this result.</p><p><strong>Conclusions: </strong>The geometry of the crystalline lens does not affect the accommodative range in early presbyopic eyes, suggesting that changes in baseline lens shape are not the primary contributor to presbyopia. In contrast to expectations based on geometrical considerations, thicker or more curved lenses did not exhibit reduced accommodation.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Binocular Vision Disorders and Contact Lens Discomfort During Soft Contact Lens Wear: A Systematic Review.","authors":"Prithwis Manna, Ankit Raj, Ankita Kumari, Mark Willcox, Fiona Stapleton, James S Wolffsohn, Mukesh Kumar","doi":"10.1007/s44402-026-00203-3","DOIUrl":"https://doi.org/10.1007/s44402-026-00203-3","url":null,"abstract":"<p><strong>Purpose: </strong>To synthesise and critically evaluate the evidence regarding accommodative and binocular vision dysfunction systematically in relation to visual discomfort during soft contact lens wear in non-presbyopic individuals, and to examine the association between soft contact lens optical designs and objective measures of accommodation and vergence.</p><p><strong>Recent findings: </strong>A systematic search of PubMed, Scopus and Google Scholar (inception to 13 May 2026) identified 403 records, of which 23 studies met the inclusion criteria, including 16 randomised trials, five non-randomised studies and two cross-sectional studies. Evidence demonstrated consistently that centre-distance multifocal, dual-focus and extended-depth-of-focus (EDOF) soft contact lenses increased accommodative lag (1.0-1.7 D), accommodative variability (0.36-0.86 D) and near exophoria (1.8-2.4Δ), while reducing accommodative facility (4.5-9 cpm) compared with single-vision designs. Similar effects were observed across a broad range of myopic refractive errors (-1.00 to -9.25 D). In contrast, centre-near multifocal lenses were associated with lower accommodative lag and reduced near exophoria relative to single-vision and centre-distance multifocal designs. Toric soft contact lenses demonstrated improvements in near point of convergence (NPC) and subjective visual performance. Across studies evaluating symptomatic wearers, binocular vision dysfunction was reported in 23%-48% of participants and was associated with significantly greater symptom severity, as reflected by higher Ocular Surface Disease Index (OSDI) and Convergence Insufficiency Symptom Survey (CISS) scores (p < 0.001). Collectively, these findings indicate that alterations in accommodative and vergence function associated with specific soft contact lens optical designs may be associated with visual discomfort during lens wear. Given the high prevalence of binocular vision dysfunction among symptomatic contact lens wearers, a brief binocular vision screening, including accommodative facility, near heterophoria, NPC and fusional vergence testing may assist clinicians in identifying underlying causes of visual discomfort and guiding targeted management strategies.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Specialty-Designed Orthokeratology Lenses with a Reduced Corneal Central Zone Moulding Area in Children with Low Myopia: A Prospective, Randomised, Controlled Trial.","authors":"Qi Zhang, Changliang Peng, Yishu Wang, Chen Chu, Tao Yu, Jianfeng Zhu","doi":"10.1007/s44402-026-00194-1","DOIUrl":"https://doi.org/10.1007/s44402-026-00194-1","url":null,"abstract":"<p><strong>Purpose: </strong>Orthokeratology (ortho-k) is widely used for myopia control in children. Specialty-designed ortho-k lenses with a modified corneal reshaping profile may offer an alternative approach for myopia control through altered lens design characteristics. This study aimed to evaluate the efficacy and safety of this lens design in slowing axial elongation and myopia progression in children with low myopia, and to explore ocular structural predictors of the treatment response.</p><p><strong>Methods: </strong>This prospective, randomised, double-masked clinical trial enroled 80 children aged 8-14 years with low myopia (-1.00 to -3.00 D). Participants were randomly assigned (1:1) to wear either standard-design ortho-k lenses or specialty-designed ortho-k lenses designed to produce a reduced corneal central zone moulding area for 12 months. Axial length was measured at baseline and at 1, 3, 6, 9 and 12 months. The primary outcome was the change in axial length (ΔAL) over time. Secondary outcomes included changes in spherical equivalent refraction (SER) and adverse events.</p><p><strong>Results: </strong>The mean base curve squared (BC²), representing the estimated corneal central zone moulding area, was 8.73 ± 5.59 mm² in the test group, which was significantly smaller than that in the control group (11.21 ± 5.17 mm^2; t = 2.685, p = 0.008). Compared with the control group, the values of ΔAL at month 6 (0.103 ± 0.14 vs. 0.047 ± 0.11, p = 0.01), month 9 (0.141 ± 0.16 vs. 0.060 ± 0.12, p = 0.002) and month 12 (0.168 ± 0.20 vs. 0.077 ± 0.14, p = 0.004) were significantly smaller. No significant difference in severe adverse events was observed between the two groups.</p><p><strong>Conclusion: </strong>Orthokeratology effectively slowed axial elongation in children with low myopia. Specialty-designed ortho-k lenses with altered corneal reshaping characteristics demonstrated greater inhibition of axial elongation.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2500113706, retrospectively registered on 2 December 2025.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-Related Changes in Differential Corneal Thickness and Their Correlation with With-the-Rule and Against-the-Rule Corneal Astigmatism.","authors":"Dandan Liao, Xiangjie Zeng, Shuangfeng Liang, Chunyang Zhou","doi":"10.1007/s44402-026-00200-6","DOIUrl":"https://doi.org/10.1007/s44402-026-00200-6","url":null,"abstract":"<p><strong>Objective: </strong>To analyse age-related changes in differential corneal thickness (DCT) and curvature (DCC) between the two principal meridians and between the vertical and horizontal meridians, and to examine their relationship with with-the-rule (WTR) and against-the-rule (ATR) astigmatism.</p><p><strong>Methods: </strong>This retrospective study included 400 patients (100 per age group: 6-20, 21-40, 41-60 and ≥61 years). The left eye was analysed for each participant. Corneal thickness (CT) and curvature (CC) were measured within the central 3 mm zone along the two principal, vertical and horizontal meridians. The mean differential thickness (DCT1) and curvature (DCC1) between the two principal meridians, as well as the mean differential thickness (DCT2) and curvature (DCC2) between the vertical and horizontal meridians were calculated and compared across age groups. To account for axis orientation, power vector transformation was applied to DCC1, decomposing it into DCC1₀ (WTR/ATR component) and DCC1₄₅ (oblique component). Subgroup analyses restricted to WTR astigmatism were performed to control for axis orientation in the thickness analysis.</p><p><strong>Results: </strong>DCT1 decreased with age but showed no significant change in the WTR subgroup (p = 0.14), indicating the apparent decline was driven by age-related shifts in axis composition. DCT2 remained stable across age groups (p = 0.19). DCC1₀ decreased significantly with age, from -2.09 to -0.08 D (p < 0.05), while DCC1₄₅ did not change significantly (p = 0.30). DCC2 also decreased significantly with age (p < 0.05). No significant age-by-sex interactions were observed (all p > 0.05).</p><p><strong>Conclusions: </strong>After controlling for axis orientation in the WTR subgroup, DCT1 and DCT2 did not vary with age. The significant age-related decreases in DCC1₀ and DCC2 confirm that anterior CC changes are the primary drivers of the WTR-to-ATR astigmatic shift. These age-related changes were consistent between sexes.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Myopia in Europe: An Umbrella Review of Systematic Reviews and Meta-Analyses.","authors":"Miguel Angel Sanchez-Tena, Wei Pan, Weizhong Lan, Cristina Alvarez-Peregrina","doi":"10.1007/s44402-026-00195-0","DOIUrl":"https://doi.org/10.1007/s44402-026-00195-0","url":null,"abstract":"<p><strong>Purpose: </strong>Myopia is a growing public health concern worldwide. Although several systematic reviews and meta-analyses have evaluated its prevalence in Europe, findings remain inconsistent due to methodological differences. This umbrella review critically synthesised the available evidence and provided a pooled prevalence estimate based on non-overlapping primary studies.</p><p><strong>Methods: </strong>PubMed, Web of Science and Embase were searched systematically up to February 2026 for systematic reviews and meta-analyses reporting myopia prevalence in Europe. Methodological quality was assessed using AMSTAR 2. Overlap of primary studies across reviews was mapped, and a secondary random-effects meta-analysis including only unique studies was performed to avoid double counting. Subgroup analyses were conducted by age group and refractive assessment method (cycloplegic vs non-cycloplegic).</p><p><strong>Results: </strong>Five systematic reviews and meta-analyses were included. Four recent reviews demonstrated high methodological quality according to the AMSTAR 2 criteria. Considerable overlap of primary studies was identified across reviews, supporting the need for an umbrella review approach. The secondary meta-analysis included 40 unique primary studies comprising 200,127 participants and 33,153 myopia cases. Most included studies defined myopia as a spherical equivalent refraction of ≤-0.50 D, although some studies used alternative thresholds. The pooled prevalence of myopia among European children and adolescents was 12% (95% CI: 9-15%). Age-stratified analyses showed a prevalence of 8% (95% CI: 6-12%) in children <12 years and 23% (95% CI: 13-33%) in individuals ≥12 years of age. Studies using non-cycloplegic refraction reported slightly higher prevalence estimates (14%) than those using cycloplegic refraction (12%); however, the difference was not significant (p = 0.45).</p><p><strong>Conclusion: </strong>Approximately one in eight European children and adolescents is myopic, and prevalence increases substantially with age. Differences related to refractive assessment methodology should be interpreted cautiously, as no significant differences were observed between cycloplegic and non-cycloplegic studies.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who Gets Referred for What? Large Scale Analysis of Clinical, Socioeconomic and Demographic Drivers Within Electronic Optometry Referrals.","authors":"Abdullah F Alotaibi, Matthew Jinkinson, Ketan R Parmar, Glen P Martin, Philip B Morgan, Robert A Harper","doi":"10.1007/s44402-026-00198-x","DOIUrl":"https://doi.org/10.1007/s44402-026-00198-x","url":null,"abstract":"<p><strong>Objective: </strong>To provide the first large-scale analysis of Electronic Eyecare Referral System (EeRS) data, examining referral patterns, demographic differences and geographical variation by socioeconomic deprivation overall.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of 104,190 referrals submitted via the National Health Service (NHS) England North West's EeRS between June 2022 and May 2024. Descriptive analyses summarised referral destinations and putative optometric diagnoses. Chi-squared tests with Bonferroni correction examined sex differences across referral endpoints. Multivariable logistic regression assessed associations between deprivation (Index of Multiple Deprivation (IMD) decile) and condition-specific referral odds, adjusting for age, sex and ethnicity.</p><p><strong>Results: </strong>Most referrals were directed to ophthalmology in secondary care (71.6%). The most common referral endpoints were glaucoma (12.2%), other medical retina (11.6%) and YAG laser capsulotomy (11.1%). Referrals within primary care accounted for 18.2%, predominantly referrals to general practice (15.0%), while referrals to glaucoma referral filtering comprised 3.0% of all referrals. Significant sex differences in referral distribution across several subspecialty endpoints were observed (p < 0.003). Deprivation-related and geographical variation was evident, with higher odds of cataract (Odds Ratio (OR) per IMD decile 0.97, 95% CI 0.97-0.98) and paediatric binocular vision referrals (OR 0.96, 95% CI 0.94-0.98) in more deprived areas, whereas vitreoretinal, adult binocular vision and other medical retina referrals were more common in less deprived areas.</p><p><strong>Conclusions: </strong>Electronic optometry referrals showed substantial variation by condition and area-level socioeconomic context. Linking referral data to deprivation measures may help identify variation in referral activity and support strategies to improve eye examination uptake and optimise referral pathways.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation and comparison of three popular computer-based contrast sensitivity measurement techniques.","authors":"André Rino Amorim, Miguel Faria-Ribeiro","doi":"10.1007/s44402-026-00173-6","DOIUrl":"https://doi.org/10.1007/s44402-026-00173-6","url":null,"abstract":"<p><strong>Purpose: </strong>To compare three computer-based methods for measuring the contrast sensitivity function (CSF): the method of limits (LMT), the method of adjustment (ADJ) and a four-alternative forced-choice (4-AFC) paradigm using the quick CSF (qCSF) algorithm.</p><p><strong>Methods: </strong>Contrast sensitivity was assessed monocularly in 47 participants (mean age: 26.2 ± 5.6 years) using the LMT and ADJ methods with ascending and descending series (five spatial frequencies, three trials) and the qCSF method (up to 150 trials across 21 frequencies). Accuracy, reliability and precision were evaluated using paired t-tests, intraclass correlation coefficients (ICC), coefficient of repeatability (CoR) and coefficient of variation (CoV). Method durations were also compared.</p><p><strong>Results: </strong>Ascending series outperformed descending series in accuracy and reliability (p < 0.001), though descending series were 24-33% faster. The ADJ method was significantly faster than the LMT method (≤4 vs. ≥8 min for three trials) and preferred by participants. Two trials provided reasonable estimates, while a third offered marginal improvement. The qCSF method offered full CSF estimation but required ≥75 trials (~5 min) for stable precision and reliability (ICC ≈ 0.85 for the area under the log CSF). Pronounced learning effects in the 4-AFC method reduced reliability at low spatial frequencies (ICC < 0.50 at 1.5 cycles per degree), whereas subjective methods showed minimal learning.</p><p><strong>Conclusions: </strong>Ascending series should be preferred over descending series for accuracy and reliability. The ADJ method offers speed and simplicity for clinical use, while the LMT method is less efficient if linear grating orientations are used and is more demanding. The qCSF method is best suited for research, providing comprehensive CSF characterisation when ≥75 trials and practice sessions are included.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prevalence of Spectacle Non-Adaptation Among Patients Presenting at a Private Practice in Witbank, South Africa.","authors":"Bevily Nukeri, Velibanti Sukati, Pheagane Motsime William Nkoana","doi":"10.1007/s44402-026-00186-1","DOIUrl":"https://doi.org/10.1007/s44402-026-00186-1","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the prevalence of and factors associated with spectacle non-adaptation in a private optometry practice in Witbank, South Africa.</p><p><strong>Methods: </strong>A retrospective descriptive study was conducted using clinical and dispensing records of patients prescribed spectacles between January 1 and December 31, 2024. Purposeful sampling identified patients who returned with complaints of non-adaptation to spectacles. Extracted data included demographic characteristics, spectacle type and factors associated with non-adaptation. Causes were categorised as being related to the prescription, dispensing, communication, binocular vision or pathology. Descriptive statistics summarised the data.</p><p><strong>Results: </strong>During the study period, 3146 spectacles were prescribed. Of those, 155 patients returned with complaints of spectacle non-adaptation. This yielded a prevalence of 4.9%. The mean age of the affected patients was 42.22 ± 17.13 years. Females accounted for 58% of cases. Non-adaptation was most frequently associated with multifocal spectacles (54%). Prescription and dispensing-related factors caused 44% and 28% of cases, respectively. Binocular vision and pathology-related factors accounted for smaller proportions of cases.</p><p><strong>Conclusion: </strong>Spectacle non-adaptation, being observed in a small but clinically relevant proportion of patients, warrants serious attention in private practice settings. The predominance of prescription- and dispensing-related causes underscores the pressing need for rigorous accuracy and quality control throughout the optometric care process. Strengthening these areas is essential for reducing non-adaptation and ensuring continued use of spectacles.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is AI Redefining Scientific Publications?","authors":"Padmaja Sankaridurg","doi":"10.1007/s44402-026-00183-4","DOIUrl":"https://doi.org/10.1007/s44402-026-00183-4","url":null,"abstract":"","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeatability and Reproducibility of the Dry Eye Analyzer in Participants With and Without Symptoms of Dry Eye.","authors":"Reut Ifrah, Efrat Netanya","doi":"10.1007/s44402-026-00196-z","DOIUrl":"https://doi.org/10.1007/s44402-026-00196-z","url":null,"abstract":"<p><strong>Purpose: </strong>Reliable evaluation and consistency between examiners and sessions are essential for dry eye diagnosis. This study examined the inter-examiner reproducibility (IER), inter-session repeatability (ISR) and within-subject variability (WSV) of the Dry Eye Analyzer (DEA) in participants with and without dry eye symptoms.</p><p><strong>Methods: </strong>Participants with Dry Eye Questionnaire-5 (DEQ-5) scores ≥6 were classified as symptomatic. Non-invasive tear breakup time (NITBUT), Meibomian gland (MG) loss, tear meniscus height (TMH), interferometry and conjunctival redness were measured by two examiners on the same day for IER. Examiner 1 repeated measurements 1-2 weeks later for ISR. Analyses included Wilcoxon tests, Spearman correlation, weighted kappa (κw), within-subject standard deviation (Sw), repeatability limits (2.77Sw), intraclass correlation coefficients (ICCs) and Bland-Altman analysis.</p><p><strong>Results: </strong>IER included 84 participants (mean age 23 ± 2 years, range 18-34 years; 42 symptomatic). Examiner 1/Examiner 2 values were 7.2 ± 3.2/8.9 ± 3.0 s for NITBUT, 20.4 ± 7.4/20.4 ± 7.0% for upper MG loss, 27.2 ± 14.0/26.6 ± 14.0% for lower MG loss and 0.2 ± 0.0/0.2 ± 0.1 mm for TMH. Outcomes were positively correlated without significant differences for most comparisons; NITBUT differed significantly overall and in symptomatic participants. Agreement ranged from fair to good (κw 0.30-0.63), ICCs from 0.51 to 0.99 and Sw was <3.40. Mean NITBUT bias was -1.68 s overall and -2.90 s in symptomatic participants; 93-98% of observations fell within the limits of agreement. ISR included 68 participants (mean age 23 ± 2 years, range 18-32; 36 symptomatic). Session 1/Session 2 values were 7.1 ± 3.2/6.8 ± 3.1 s for NITBUT, 20.7 ± 7.4/20.7 ± 8.1% for upper MG loss, 27.0 ± 14.6/26.9 ± 13.9% for lower MG loss and 0.2 ± 0.0/0.2 ± 0.0 mm for TMH. Outcomes were positively correlated without significant differences. Agreement ranged from fair to very good (κw 0.28-1.00), with Sw < 3.14.</p><p><strong>Conclusions: </strong>DEA reliability was parameter-dependent. MG-loss measurements showed excellent IER and low WSV, whereas NITBUT showed moderate reliability and examiner-related bias. NITBUT and TMH should be interpreted cautiously during follow-up.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}