A modified 3D stereophotogrammetry-based distraction test for assessing lower eyelid tension
Authors:   Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China; Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne 50937, Nordrhein-Westfalen, Germany, Hou Xiao-Yi , Meinke Marius M. ,   Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne 50937, Nordrhein-Westfalen, Germany, Li Sen-Mao ,   Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne 50937, Nordrhein-Westfalen, Germany, Lin Ming ,   Department of Ophthalmology, Ninth People&#x2019;s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China, Jia Ren-Bing ,   Department of Ophthalmology, Ninth People&#x2019;s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China, Guo Yong-Wei ,   Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China, Heindl Ludwig M. ,   Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne 50937, Nordrhein-Westfalen, Germany; Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne 50937, Nordrhein-Westfalen, Germany
Published: October 2022

AIM: To investigate the reliability of a modified three-dimensional distraction test (3D-DT) and three-dimensional pinch test (3D-PT) for assessing lower eyelid tension (LET).
METHODS: A cross-sectional study was conducted among 97 volunteers including 97 eyelids with no history of trauma, tumor, or reconstructive surgeries. Six three-dimensional photographs were acquired for each participant, including two photographs obtained in a neutral position (NP), two using a modified 3D-DT with a 15.9-grammes stainless steel eyelid hook performed, and two using 3D-PT.
RESULTS: The mean absolute differences between NP, 3D-DT, and 3D-PT measurements varied between 0.07 and 7.42, 0.10 and 13.10, and 0.07 and 15.97, respectively; technical error of measurement varied between 0.05 and 7.81, 0.09 and 10.19, and 0.07 and 12.47, respectively; and relative error measurements varied between 0.10% and 11.50%, 0.16% and 30.51%, and 0.11% and 38.75%, respectively. For intra-rater reliability, the intraclass correlation coefficients (ICCs) were more than 0.80 in seven out of eight measurements obtained in the NP and 3D-DT, whereas those obtained in the 3D-PT were as low as less than 0.30 by rater 1; the ICCs of all the measurements obtained in all the positions (NP, 3D-DT, and 3D-PT) were more than 0.80 by rater 2. For inter-rater reliability six out of eight NP and 3D-DT measurements had an ICC greater than 0.80, whereas those of 3D-PT measurements were less than 0.30. For intra-method reliability, the ICCs of all the NP measurements were more than 0.87, whereas those of the six 3D-DT measurements and four 3D-PT measurements were more than 0.80.
CONCLUSION: Our study results prove that the modified 3D-DT, which involves the use of an eyelid hook, can be a highly reliable method for evaluating LET. Furthermore, this novel and simple method may be utilized as the basis for further investigation and routine pre- and postoperative clinical evaluation.