Dry Eye Symptom Screens Show Modest Accuracy

By Marilynn Larkin

November 26, 2018

NEW YORK (Reuters Health) - In head-to-head comparisons, two of five dry eye screens showed a statistically significant ability to detect signs of the disorder, but all demonstrated relatively modest diagnostic accuracy, researchers say.

Several dry-eye symptomology questionnaires are available. However, their accuracy as screening instruments "can be influenced by the multifactorial nature of dry eye disease, and the complex inter-relationships between ocular surface inflammation, tear film homeostasis, somatosensory pathways, and symptomatic experiences," said Dr. Michael TM Wang and Jennifer P. Craig of the New Zealand National Eye Centre at the University of Auckland in a joint email to Reuters Health.

Recently, the international Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) recommended the use of the Ocular Surface Disease Index (OSDI) and 5-item Dry Eye Questionnaire (DEQ-5) as part of the dry eye diagnostic criteria.

Drs. Wang and Craig compared the accuracy of these screens with that of the McMonnies Dry Eye Questionnaire, Symptom Assessment in Dry Eye (SANDE) and Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire.

As reported online November 8 in JAMA Ophthalmology, 211 participants were recruited. The mean age was 41; 58.8% were women; 60.7% were of European ethnicity; 25.6%, East Asian; 11.4%, South Asian; and 2.4%, other.

Each participant's right eye was evaluated using a keratography, and tear film osmolarity was measured in both eyes.

Overall, 69.2% participants fulfilled the TFOS DEWS II criteria for dry eye signs, i.e., the median noninvasive tear film breakup time was 8.6 seconds; the mean tear osmolarity was 310 mOsm/L; and the mean interocular difference in osmolarity was 8 mOsm/L.

Seventy-one (33.6%) participants had more than five corneal spots; 107 (50.7%) had more than nine conjunctival spots; and 97(46.0%) had eyelid margin staining 2 mm or greater in length and 25% or greater in width.

The accuracy of the OSDI and SANDE scores in diagnosis dry eye were significantly greater than chance; however, scores of the SPEED, DEQ-5 and McMonnies Dry Eye Questionnaire were not.

"The OSDI is a 12-question screening instrument which explores dry eye symptomology and its impact on visual function and quality of life, while the SANDE questionnaire is based on two visual analogue scales which asks patients to rate the overall frequency and severity of their symptoms," Drs. Wang and Craig said.

"The differing nature of the two questionnaires might mean that they may be more applicable in different contexts," they pointed out. "For example, the OSDI might be useful for a global evaluation of dry eye symptoms and their impact on the patient, while the SANDE, being relatively shorter and less time-consuming to complete, might be better suited for repeated measurements taken over a period of time, such as when monitoring the therapeutic effects of dry eye treatments."

"Overall, though," they concluded, "all the validated questionnaires demonstrated relatively modest diagnostic accuracy values, which would support the TFOS DEWS II recommendations that careful evaluation for clinical signs of tear film homeostatic disturbance would be warranted, should a positive score be obtained on the screening symptomology questionnaire."

In a separate email, Dr. Craig noted that compared to these screening tools, "dry eye test strips might seem easier (from the clinician’s perspective), but they are far from reliable, and would identify probably around 1 - 3% of all cases of dry eye disease, only."

Dr. Christine Shieh, Assistant Professor at Vanderbilt Eye Institute in Nashville, told Reuters Health by email, "In my clinic, I continue to use the OSDI questionnaire. The OSDI is perhaps the most widely used patient questionnaire in the published literature."

"If the TFOS DEWS II Diagnostic Methodology Report had found that another validated patient questionnaire was clearly superior over the OSDI, the findings would have led me to consider whether I should change to a different dry eye patient questionnaire," she added.

Participants were mainly of European, East Asian and South Asian ethnicity, she noted, and did not have eye surgery for at least three months prior to the study. "It is possible that patients of other ethnic backgrounds, or who have had recent eye surgery, may perceive/report on their dry eye differently on validated dry eye patient questionnaires."

"Future research will be needed to determine whether specific populations benefit from different validated patient questionnaires," Dr. Shieh concluded.

SOURCE: http://bit.ly/2K8uk8k

JAMA Ophthalmol 2018.

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