Abstract
Purpose
Evaluating anti-scarring therapies require objective assessment of scarring, and knowledge of normal fornix anatomy. Measurement of conjunctival scarring has focused on inferior fornix shortening, although the superior fornix is often overlooked. There are data on normal fornix depth (FD) in South Asians, but there are no studies investigating normal conjunctival FD in white Caucasians. We designed a fornix depth measurer (FDM) for objective measurement of upper and lower conjunctival FD. The purpose of this study was to evaluate intra- and inter-observer variability, and to establish a reference for normal conjunctival FD in an ethnically white Caucasian population.
Patients and methods
Prospective cross-sectional study evaluating conjunctival FD in 252 clinically normal white Caucasian participants aged 20–80. Paired observers evaluated inter- and intra-observer variability. Data was analyzed using Bland–Altman plots and analysis of variance.
Results
For white Caucasian subjects, mean upper and lower conjunctival fornix depths were 15.6 mm (95% confidence interval (CI), 12.5–18.8) and 10.9 mm (95% CI, 8.0–13.7), respectively. Females have smaller FDs (upper FD 15.3 mm±1.6 females, 16.2 mm±1.4 males, P<0.001; lower FD 10.6 mm±1.3 females, 11.3 mm±1.4 males, P<0.001). There was a progressive decline in FD with age (upper fornix depth 16.3 mm±1.2 at age 20–29, and 15.0 mm±1.8 at age 80+ (P=0.04)). There was 94–100% intra-observer and inter-observer agreement for upper and lower fornix measurements.
Conclusions
Using a slightly different custom-designed FDM, central conjunctival fornix depth in white Caucasian eyes appears to be similar to data previously reported in South Asian eyes. Fornix depth measurements were repeatable and reproducible.
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Acknowledgements
VS was supported by the NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology. The authors have been grateful for the support and advice of Professor John Dart (Moorfields Eye Hospital), Catey Bunce (Moorfields Eye Hospital), Darwin Minassian (Moorfields Eye Hospital), Saaeha Rauz (Birmingham & Midland Eye Centre) and Geraint Williams (Birmingham & Midland Eye Centre) during this study.
Author contributions
Substantial contributions to the conception or design of the work: VS, DC and SH. Acquisition, analysis or interpretation of data: GJ, CD, SH, DB, HJ, ET, DC and VS. Drafting the work or revising it critically for important intellectual content: VS, GJ, SH, CD, DB, HJ, ET and DC. Final approval of the version published: GJ, DC, SH, DB, HJ, ET, CD and VS. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: GJ, DC, SH, DB, HJ, ET, CD and VS.
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Jutley, G., Carpenter, D., Hau, S. et al. Upper and lower conjunctival fornix depth in healthy white caucasian eyes: a method of objective assessment. Eye 30, 1351–1358 (2016). https://doi.org/10.1038/eye.2016.128
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DOI: https://doi.org/10.1038/eye.2016.128
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