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Validation of an Objective Measure of Dry Eye Severity.

ABSTRACT: Purpose:We evaluated the validity of a single dry eye severity measure estimated using Rasch analysis from a battery of clinical tests and patient symptoms. Methods:This study included 203 dry eye patients and 51 controls. Administered tests included the Ocular Surface Disease Index (OSDI), tear osmolarity, Schirmer's test, noninvasive break-up time, and ocular surface staining. Each of the 12 OSDI questions and each clinical test was defined to be a separate indicator to estimate a single dry eye severity measure from Rasch analysis. Measures of severity were estimated for each subject (person measures) and measures of sensitivity to severity were estimated for each sign and symptom (indicator measures). Results:The average severity measure for dry eye patients was significantly greater than the average severity measure for controls (-0.39 vs. -1.2, P < 0.001). The distribution of indicator measures was well matched to the distribution of person measures. No indicator carried >10% of the total information about dry eye severity carried by all indicators together. However, the most informative indicators were corneal and conjunctival staining. Conclusions:Our study indicated that there is no single "best" dry eye test. Clinical tests and symptoms should be used in combination to estimate a single dry eye severity measure. Translational Relevance:There is no single "gold standard" testing method for dry eye that correlates with the severity of disease. We propose that Rasch analysis can be used to calculate an objective dry eye severity score from a battery of clinical indicators.

SUBMITTER: Karakus S

PROVIDER: S-EPMC6183328 | biostudies-other | 2018 Sep

REPOSITORIES: biostudies-other

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Validation of an Objective Measure of Dry Eye Severity.

Karakus Sezen S Akpek Esen K EK Agrawal Devika D Massof Robert W RW

Translational vision science & technology 20180901 5

<h4>Purpose</h4>We evaluated the validity of a single dry eye severity measure estimated using Rasch analysis from a battery of clinical tests and patient symptoms.<h4>Methods</h4>This study included 203 dry eye patients and 51 controls. Administered tests included the Ocular Surface Disease Index (OSDI), tear osmolarity, Schirmer's test, noninvasive break-up time, and ocular surface staining. Each of the 12 OSDI questions and each clinical test was defined to be a separate indicator to estimate ...[more]

PMID: 30323999

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Project description:PurposeTo evaluate the association of dry eye disease (DED) severity with work productivity and activity impairment.DesignLongitudinal, observational study within a randomized clinical trial.ParticipantsPeople with moderate to severe DED who enrolled in the multicenter Dry Eye Assessment and Management (DREAM) study.MethodsParticipants completed the Work Productivity and Activity Impairment questionnaire at 0, 6, and 12 months and were assessed in parallel for symptoms and signs (conjunctival and corneal staining, tear film break-up time [TBUT], and Schirmer test) of DED. Associations of work productivity and activity impairment with symptom and signs were evaluated with linear regression models using generalized estimating equations and controlling for demographics and comorbidities.Main outcome measuresWork productivity (employment, absenteeism, presenteeism, overall work impairment) and activity impairment.ResultsAmong 535 participants at baseline, 279 (52%) were employed, and mean activity impairment was 24.5%. Among those employed, the mean score was 2% for absenteeism, 18% for presenteeism, and 19.6% for overall work impairment. Higher Ocular Surface Disease Index (OSDI) symptom scores were associated with greater absenteeism, presenteeism, and activity impairment. Overall work impairment and activity impairment were greater by 4.3% and 4.8%, respectively, per 10-unit difference in OSDI score (P < 0.001). Longitudinal increases (worsening) in OSDI scores were associated with increasing impairment in work and non-work-related activity: 2.0% and 3.1% per 10 units in OSDI, respectively (P < 0.01). Worse corneal staining and TBUT were associated with higher overall work impairment and activity level (P ≤ 0.04). However, longitudinal changes in these two signs were not associated with changes in work productivity or activity impairment.ConclusionsWorse symptoms of DED are associated with decreased work productivity and activity level, both cross-sectionally (interindividually) and longitudinally within person (intraindividually). Corneal staining and TBUT are associated with interindividual differences but not intraindividual changes in work productivity and activity impairment.

Project description:PurposeTo investigate the effects of high-intensity use of smartphones on ocular surface homeostasis and to explore whether high-intensity use of handheld digital devices can cause false increase of dry eye diagnostic rate.MethodsIn this prospective self-control study, 60 subjects (120 eyes) were recruited and asked to read on smartphones provided by the same manufacturer for two consecutive hours. This study was conducted during 8:00 - 10:00 AM to eliminate the influence of digital equipment used the previous day. Ophthalmological examinations [non-invasive tear breakup time (NIBUT), fluorescein breakup time (FBUT), Schirmer I test, corneal fluorescein staining (CFS), bulbar conjunctival redness and meibomian gland (MG) assessment] and a questionnaire survey were conducted before and after the reading test. Based on the collected data, the changes in ocular surface damage and subjective symptoms of the subjects were evaluated, and the differences in the diagnostic rate of dry eye before and after high-intensity use of smartphones were compared.ResultsThe diagnostic rate of dry eye was sharply increased (61.7% vs. 74.2%). The severity of dry eye also changed significantly, and the moderate and severe degree increased after reading (10% vs. 15%; 5% vs. 10.8%). The aggravated severity subjects had lower MG expressibility and more evident bulbar conjunctival redness compared to the non-aggravated severity subjects. After 2 h of continuous reading, NIBUT-First, NIBUT-Average and FBUT-Average were significantly decreased, while the proportion of BUT ≤ 5 s increased significantly. Non-invasive keratograph tear meniscus height(NIKTMH) decreased significantly compared to the baseline level, while the proportion of NIKTMH<0.20 mm increased significantly. No significant difference was observed in the Schirmer I test and CFS score between the two groups. Compared to the baseline, evident aggravation was observed in bulbar conjunctival redness. The Ocular Surface Disease Index (OSDI) was significantly higher than the baseline after the reading test.ConclusionDiagnostic indicators related to dry eye are rapidly deteriorating after high-intensity smartphone use, especially those with lower MG expressibility and ocular redness. High-intensity smartphone use can increase the false positive rate of dry eye diagnosis by disturbing ocular surface homeostasis.

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Validation of an Objective Measure of Dry Eye Severity.

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Validation of an Objective Measure of Dry Eye Severity.

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