Comparison of the performance of the dry eye questionnaire (DEQ-5) to the ocular surface disease index in a non-clinical population

ObjectiveTo compare the performance of the dry eye questionnaire (DEQ-5) with the Ocular Surface Disease Index (OSDI) and further validate the DEQ-5 questionnaire.MethodsA population-based cross-sectional study conducted in Ghana. OSDI and DEQ-5 questionnaires were administered to participants. Cronbach’s alpha was used to evaluate the reliability of the OSDI and DEQ-5 questionnaires. Analysis of variance was used to evaluate the discriminant validity of DEQ-5. Concurrent validity was evaluated using the Spearman correlation analysis. A receiver operating characteristic (ROC) curve was generated to describe the sensitivity and specificity of the DEQ-5 questionnaire for diagnosis of dry eye symptoms. Cohen Kappa was used to evaluate agreement between the two questionnaires.ResultsThe reliability of the overall OSDI and DEQ-5 scores were 0.919 and 0.819 respectively. The mean (SD) DEQ-5 scores for asymptomatic, mild, moderate and severe dry eye symptoms as defined by the OSDI grading were 3.05 (2.73), 5.13 (3.69), 7.65 (3.30) and 9.77 (4.16) respectively. There was a statistically significant correlation between total OSDI and total DEQ-5 scores (r_s = 0.649, p < 0.0001). The area under the curve (AUC) of the ROC curve for DEQ-5 was 0.835 (95 % CI: 0.796 – 0.875). A DEQ-5 threshold of 5.5 yielded maximum sensitivity (0.712) and specificity (0.827). The Cohen kappa using a the DEQ-5 total score threshold of 5.5 was K = 0.539 (p < 0.0001).ConclusionIn conclusion, performance of the DEQ-5 questionnaire in discriminating symptoms of dry eye is comparable to the OSDI questionnaire. The DEQ-5 questionnaire is a valid measure of dry eye symptoms and can be used as a dry eye symptoms assessment tool in both clinical and epidemiological studies.     

Association between symptoms of xerostomia and dry eye in older people

PurposeTo explore the association between xerostomia and dry eye symptoms in the older adult population.MethodsSecondary analysis of data from 627 participants (346 male, 291 female), with a mean ± SD age of 75 ± 7 years, recruited through the population-based South Australian Dental Longitudinal Study. Participants completed the validated Summated Xerostomia Inventory–Dutch Version questionnaire (SXI-D), and rated their overall frequency of dry eye symptoms at baseline.ResultsSymptomatic dry eye was reported by 31% of participants, and xerostomia by 21%. A positive correlation was observed between dry eye symptoms and SXI-D scores (Spearman’s rho = +0.379, p < 0.001). Overall, participants with symptomatic dry eye had higher SXI-D scores than those without (10.6 ± 3.6 vs. 8.1 ± 2.8, p < 0.001), and were more likely to report xerostomia, with an odds ratio (95% CI) of 2.25 (1.52–3.35; p < 0.001).ConclusionsSymptoms of xerostomia and dry eye were relatively common in the cohort of older adult participants. The potentially debilitating implications of – and positive association between – the two types of sicca symptoms support the routine evaluation of xerostomia symptoms as part of the assessment of dry eye patients, and vice versa.     

Prevalence and associated risk factors of symptomatic dry eye in Ghana: A cross-sectional population-based study

PurposeThis study sought to estimate the prevalence and associated risk factors of symptomatic dry eye in the general non-clinical Ghanaian population.MethodsThis was a cross-sectional population-based study conducted from November 2019 to February 2020. A stratified, multistage, random sampling technique was used to select participants aged 18 years and above from the capital cities of eight administrative regions in Ghana. Symptomatic dry eye was assessed using the Ocular Surface Disease Index questionnaire (OSDI). A study specific structured questionnaire was administered to collect information on participants’ demographics and self-reported risk factors of dry eye disease such as smoking, diabetes, hypertension, arthritis, ocular allergies, pregnancy, contact lens wear, use of topical glaucoma medication and multivitamin supplement. Multiple linear regression analysis was used to explore associations between symptomatic dry eye and participant characteristics. A p-value of 0.05 was considered statistically significant.ResultsA total of 1316 individuals participated in the study [mean (SD) age 37.0 (15.72) years; range 18–90 years; 50.2 % males]. The prevalence of symptomatic dry eye was 69.3 % [95 % CI: 66.7 % - 71.7 %; mean (SD) OSDI score of 26.97 (21.52)]: 19.8 %, 16.6 % and 32.9 % mild, moderate and severe symptoms respectively. The most common ocular symptom was sensitivity to light (experienced at least some of the time), reported by 67.1 % of participants; most affected vision-related activity was reading (49.3 %); most common environmental trigger of dry eye symptoms was windy conditions (61.3 %). There was a significant positive association between symptomatic dry eye and age (p < .0001), female sex (p = .026), arthritis (p = .031), ocular surface allergy (p = .036) and regional zone (p = .043).ConclusionThere is a high prevalence of dry eye symptoms in Ghana. This represents a high dry eye disease burden and a significant public health problem that needs immediate attention.     

Italian translation and validation of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8)

PurposeTo translate and validate an Italian version of the CLDEQ-8 (CLDEQ-8_IT).MethodsThe study was carried out in two phases. In the first phase, a cross-cultural adaptation of CLDEQ-8 to Italian was performed by forward and backward translation in sequence. In the second phase, a multi-centre study was conducted for the validation of the questionnaire. Validity CLDEQ-8_IT was evaluated against three gestalt questions: overall opinion of soft contact lenses (CLs), global self-assessments of eye sensitivity and eye dryness. Reliability was evaluated by test–retest assessment in a subgroup of subjects. Finally, the psychometric properties of CLDEQ-8_IT were explored by Rasch analysis.ResultsTwo hundred and forty soft CL wearers, fluent Italian speakers (73 males and 167 females), between 18 and 70 years of age were enrolled. A significant correlation was found between CLDEQ-8_IT and each of the three Gestalt questions. The cutoff score of 12 points demonstrated the best balance between sensitivity and specificity in differentiating wearers grading their CLs as “Excellent/Very good” from those reporting their overall opinion as “Good/Fair/Poor”. The Intraclass Correlation Coefficient between test and retest was 0.88 (95% CI: 0.81–0.92). Finally, infit and outfit statistics using Rasch analysis for the 8 items were in a good range, however Principal Components Analysis revealed a certain degree of multi-dimensionality of the instrument. Also, item 8 analysis could be computed after merging the last two response categories.ConclusionThe CLDEQ-8_IT showed very good validity and reliability in measuring symptoms of CL wearers, comparable to the original English language version. A cut-off of 12 was confirmed as yielding the best balance between sensitivity and specificity in detecting CL wearers who could benefit from clinical management of their CL-related symptoms. Collapsing of the response options 5 and 6 in the last item of questionnaire could optimise its functioning.     

Translation and validation of the contact lens dry eye questionnaire-8 (CLDEQ-8) to the Spanish language

PurposeTo present the process of cultural and psychometric adaptation, and clinical validation of a new version in the Spanish language of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8).Materials and methodsThe translation-retro-translation method was applied to the CLDEQ-8 questionnaire. Two independent native Spanish-speaking translators adapted the questionnaire from English to Spanish, and then a committee of experienced clinicians (CE) evaluated the semantic equivalence and designed a Spanish version of the CLDEQ-8 questionnaire. The resulting translated version was tested conducting a pilot study in contact lens users and assessing their perception and overall understanding of the terminology. The results were analyzed and a final version was designed. The final version was retro-translated to English by a native English-speaking translator and compared with the original CLDEQ-8 version to confirm there were no meaningful differences. To clinically validate the new instrument, a prospective study was conducted to apply the new Spanish CLDEQ-8 to 50 contact lens users.ResultsFifty patients were studied with an average age of 21.50 ± 1.66 years. The average CLDEQ-8 score was 13.28 ± 6.81 points (range 1–31). The internal consistency (Cronbach's alpha) was 0.89, with a corrected index of homogeneity >0.50 for all evaluated items.ConclusionsThe process of trans-cultural adaptation of the questionnaire CLDEQ-8 resulted in the elaboration of a reliable and much needed instrument capable of measuring frequency and intensity of dry eye symptoms in Spanish-speaking contact lens users.     

Validation and reliability of the Turkish version of Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8)

PurposeContact lens dry eye questionnaire-8 (CLDEQ-8) quantifies the disturbing symptoms with the aim of assessing the satisfaction and overall opinion of contact lens wearers. The aim of this study was to develop Turkish version and to evaluate the validity and reliability of the questionnaire.MethodsCLDEQ-8 was translated into Turkish language, using the back translation methods. In a sample of 10 individuals, validation of translation was checked as pre-test evaluation. Turkish version of CLDEQ-8 questionnaire was conducted in 100 soft contact lens wearers. Validity was investigated using Rasch analysis and reliability by Cronbach’s alpha (α) and person separation index (PSI).ResultsThe participants were healthy other than refractive errors. Their mean age was 25.19 ± 7.03 years and male to female ratio was 14/86. All of them were silicone-hydrogel soft contact lens wearers. Their contact lens history was 3.13 ± 3.77 years and mean refraction error was -2.69 ± 1.64 diopters.The whole 8 items were consistent with the Rasch model (p > 0.05) and unidimensional (paired t test, p = 0.1). Both Cronbach’s alpha and PSI values were higher than 0.7 (α = 0.873, PSI = 0.867). There were not functional differences in questionnaire items regarding overall age groups (Andersen LR test, p = 0.518).ConclusionTurkish version of the CLDEQ-8 conforms to the Rasch model and provides the one dimensional assumption. The questionnaire has internal consistency, is valid and reliable in Turkish contact lens wearers.     

Development of a contact Lens risk survey

PurposeTo describe the development and report psychometric properties of the Contact Lens Risk Survey (CLRS) to identify patients at risk for soft contact lens-related complications.MethodsPsychometric properties of the CLRS, a web-based survey with branching logic, were determined using data from 5 multi-site fieldings (n = 1059), including re-fielding to sub groups. Responses from participants with and without an active red eye were used to identify risk factors of a red eye event and calculate an overall risk score. A 6th fielding of the CLRS (n = 171) was used to assess discriminate validity.ResultsParticipants needed 11−12 min to complete the survey with a negligible difference by age. Internal consistency was excellent (Cronbach’s α ≥ 0.70) for 3 of the 5 constructs identified by factor analysis. Twelve of the 17 survey items exhibited excellent within-subject repeatability (Kappa ≥ 0.61). Between-subject agreement, assessed in 18−25 year olds, was high for the majority of items, suggesting good generalizability across different populations of SCL wearers. The ability of the model using individual items of the CLRS to discriminate Controls and participants with a red eye was good with an area under the curve of 0.779.ConclusionThe CLRS tool is a repeatable and valid instrument to standardize documentation of demographic, behavior, and exposure factors which appear to drive the greatest risk of a contact lens related red eye event.     

Application of systane complete for the treatment of contact lens discomfort

PurposeTo understand the safety of treating contact lens (CL) discomfort with a new artificial tear when it is directly applied to a CL-wearing eye.MethodsThis was a two-week, two-visit, double-masked study that randomized participants with CL discomfort to use Systane Complete (artificial tear), Sensitive Eyes (rewetting drop), or no treatment. Drops were applied before, twice during, and after CL use each day. Corneal staining served as the primary safety metric. Conjunctival staining, tear break-up time, Schirmer’s test, CL comfort (Contact Lens Dry Eye Questionnaire-8 [CLDEQ-8]), and dry eye symptoms (Standardized Patient Evaluation of Eye Dryness [SPEED]) were also evaluated.ResultsThis study recruited 73 participants with a mean age of 30.3 ± 11.5 years; 18 % of the participants were male. There were no significant changes in ocular surface signs from baseline or between the artificial tear and rewetting drop groups after two weeks (p ≥ 0.05). Participants in the artificial tear and rewetting drop groups had significant improvements in CLDEQ-8 scores after two weeks of treatment compared with baseline (p < 0.0001), though scores for this test were not significantly different between these groups after two weeks (p = 0.94). CLDEQ-8 scores were significantly better in the artificial tear and rewetting drop groups compared with no treatment after two weeks (p < 0.0001).ConclusionsBoth drops were found to be safe for use with CLs while also significantly improving ocular symptoms compared to no treatment after two weeks of use.     

Estimates of dry eye disease in Saudi Arabia based on a short questionnaire of prevalence,symptoms, and risk factors: The Twaiq Mountain Eye Study I

PurposeTo estimate the prevalence and associated risk factors of dry eye disease (DED) among the citizens of Saudi Arabia.MethodsA cross-sectional prevalence survey was administered to 4066 healthy adults from the five main regions of Saudi Arabia. Initial estimates of the prevalence and associated risk factors of DED were calculated for the general population and then stratified by demographic characteristics such as age, sex, and location. DED was assessed by a short, validated dry-eye questionnaire.ResultsThe overall prevalence of DED was 49.5 % (n = 2016), including 33.1 % (n = 1347) of participants who reported a previous DED diagnosis and 16.4 % (n = 669) who reported severe symptoms; 14.7 % reported severe symptoms and a previous DED diagnosis (n = 598). The DED prevalence among men was 49.8 % (n = 1005) compared with 50.2 % (n = 1011) for women. The multivariate model analysis confirmed the increased prevalence of DED in women (OR 1.48; 95 % CI 1.30–1.88), those ≥60 years of age (OR 1.99; 95 % CI 1.60–2.81), those who had undergone refractive surgery (OR 1.79; 95 % CI 1.50–2.59), those having undergone acne treatment (OR 1.51; 95 % CI 1.34–1.97), contact lens wearers (OR 1.77; 95 % CI 1.40–2.48), those having taken antiallergy drugs (OR 2.23; 95 % CI 1.55–2.78) or antidepressants (OR 1.60; 95 % CI 1.14–2.44), and those who reported computer use of >6 h per day (OR 1.66; 95 % CI 1.41–2.52).ConclusionDry eye is a common disease among the Saudi Arabian population. Prevalence is found to be high and vary significantly across the country. DED could be attributed to dry weather, low annual rainfall, low humidity, widespread use of air conditioners, air pollution, high temperature, and exposure to sunlight.     

Assessment of four validated questionnaires for screening of dry eye disease in an African cohort

PurposeTo evaluate the 5-item dry eye questionnaire (DEQ-5) for measurement precision and unidimensionality, and assess the ability of Ocular Surface Disease Index (OSDI), McMonnies Dry Eye Questionnaire (MQ), Ocular Comfort Index questionnaires (OCI), and DEQ to predict clinical measures of DED in an African population.MethodParticipants (n = 113; mean age 24.7 ± 5.4 years) completed all four questionnaires administered in a randomized order. Internal consistency and test-retest reliability of the instruments were assessed. A masked examiner performed clinical dry eye tests in both eyes of participants and the results used to classify into either “dry” or “non-dry” groups. The diagnostic criteria for dry eye disease were tear break up time (TBUT) < 10 s plus at least one of Schirmer <15 mm in 5 min., > 5 corneal staining spot, or > 9 conjunctival staining spots. Rasch analysis was performed to assess the DEQ for unidimensionality and measurement precision, and receiver operating characteristic curve (AUC) analysis was used to assess the ability of the four questionnaires to predict clinical measures of DED.ResultsThe responses from the DEQ-5 met the Rasch analysis criterion of unidimensionality with infit and outfit values of between 0.74–1.43 mean-square and 0.69–1.49 mean-square, respectively, and measurement precision of 2.33. Internal consistency and test-retest reliability of each test was high, with Cronbach alpha >0.70 for the questionnaire and their respective subscales but internal consistency reliability of the MQ was poor (Cronbach’s alpha = 0 .29?0 0.52). Each test segregated the “dry” and “non-dry” groups with moderate (all AUC 0.70?0.80) and similar accuracy (P > .05).ConclusionThe DEQ -5 demonstrated adequate measurement precision and unidimensionality. Each of the four questionnaires showed psychometric validity for clinical use in the African population, and modest and similar accuracy when screening for dry eye signs but the performance of the McMonnies questionnaire was limited in terms of internal consistency reliability.     

Prevalence and risk factors of symptomatic dry eye disease in Lebanon

PurposeTo estimate the prevalence of symptomatic dry eye disease (DED) and investigate its associated risk factors in the Lebanese population.MethodsPopulation-based cross-sectional study of 602 participants from Lebanon aged 18 years and older. Ocular Surface Disease Index (OSDI) questionnaire on dry eye symptoms was used to evaluate the prevalence of symptomatic DED. Chi-square test was used to investigate the association between DED status and risk factors such as age, gender and smoking tobacco.ResultsThe percentage of DED among the study population (271 males and 331 females) was 36.4% with OSDI score ≥ 13 (mild to moderate and severe OSDI status). The most reported DED symptom in the population was sensitivity to light. Smokers reported higher DED symptoms than non-smokers. Older and smoker populations were more likely to report significantly higher OSDI scores (p < 0.05). Moreover, gender was not statistically associated with DED (p > 0.05).ConclusionSymptomatic DED is substantial in Lebanon. It is statistically associated with the age of population and their tobacco exposure.     

Patient-reported experience of dry eye management: An international multicentre survey

PurposeTo explore the journey taken by patients in a range of different countries to manage their dry eye symptoms.MethodMembers of the general public who responded positively to the question “Do your eyes ever feel dry?” completed a questionnaire describing their demographics, the impact of their symptomology, the advice they have received and the management options they have tried. The Ocular Surface Disease Index (OSDI) questionnaire was also completed.ResultsA total of 916 individuals (Canada = 235, Mexico = 127, New Zealand = 157, Taiwan = 246, UK = 151) of similar age distribution (median 38 years, IQR: 27–50) completed the survey. The reported duration of symptoms was longest in Canada (median 4 years, range 2–10) and least in Taiwan (2 years, range 1–3; p < 0.001), and similar trends were observed for symptom severity (p = 0.001). However, there was no statistically significant difference between countries with respect to the impact of symptoms on quality of life (median 3/10; p = 0.08). Less than half of the individuals in any country had consulted with a health professional. About half had tried a treatment for their dry eye symptoms, with artificial tears being the most common treatment, followed by warm compresses, and both therapies were rated as reasonably effective (median 5?7/10).ConclusionMany people with dry eye symptoms are not consulting health care professionals who can confirm the diagnosis, exclude differential diagnoses, and offer a wide range of treatments targeted at the dry eye subtype.     

Determining initial ocular comfort differences between 0.7% olopatadine and 0.035% ketotifen fumarate

PurposeTo compare the ocular comfort at application of topical, over-the-counter, 0.7% olopatadine and 0.035% ketotifen fumarate anti-allergy eye drops.MethodsThis study recruited participants who were minimally symptomatic based upon Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire scores (≤3 units) and who had minimal between-eye inter-ocular comfort differences as judged by visual analog scale scores (VAS; ≤7 units). Baseline comfort was evaluated by eye with a VAS. One drop of 0.7% olopatadine or 0.035% ketotifen fumarate was then applied to the right eye with the alternative drop being immediately applied to the left eye. Participants were next evaluated with the same comfort VAS by eye at drop application, and then at 30 s, 1 min, and 2 min post-application. LogMAR visual acuities and bulbar conjunctival redness were evaluated pre- and post-drop application to judge initial changes.ResultsThis study enrolled 159 participants who had a mean ± SD age of 26.3 ± 7.7 years, and 78.6% of the participants were female. The VAS found that the 0.7% olopatadine drop was more comfortable than the 0.035% ketotifen fumarate drop at all time-points. There were no between-eye differences in LogMAR visual acuities, yet bulbar redness was significantly less in 0.7% olopatadine treated eyes compared 0.035% ketotifen fumarate treated eyes.ConclusionThis study found that topically applied 0.7% olopatadine drops were initially more comfortable than 0.035% ketotifen fumarate drops.     

Visual function,ocular surface integrity and symptomatology of a new extended depth-of-focus and a conventional multifocal contact lens

PurposeTo evaluate visual function, ocular surface integrity and dry eye symptoms with an extended depth-of-focus (EDOF) design and a conventional multifocal (MF) contact lens (CL) after 15 days of wear.MethodsA crossover single mask randomised clinical trial was conducted including 30 presbyopes who used an EDOF and a conventional MF CL (Biofinity MF) for 15 days each. Defocus curves, depth-of-focus range, contrast sensitivity (CS) under photopic and mesopic conditions (with and without glare) and subjective perception of halos and glare were evaluated. The ocular surface was evaluated through non-invasive Keratograph tear breakup time (NIKBUT), averaged tear breakup time (NIKBUT-avg), tear meniscus height (TMH), bulbar and limbal redness, and conjunctival and corneal staining. Dry eye symptoms were assessed with the OSDI questionnaire.ResultsNo statistically significant differences were found for defocus curves or depth-of-focus between the two CLs (both p > 0.05). Subjective perception of halos and glare was not significantly different between CLs. Statistically significant differences were observed for CS under mesopic conditions for low spatial frequencies (p = 0.008). None of the CL produced significant changes in NIKBUT, NIKBUT-avg, TMH or redness. No change in conjunctival staining was observed in 76.7 % and 73.3 % of participants for EDOF and Biofinity MF, respectively. No change in corneal staining was observed in 86.7 % and 83.3 % of participants for EDOF and Biofinity MF, respectively. No changes were observed in the symptomatology measured with OSDI questionnaire (p > 0.05).ConclusionsBoth CL for presbyopia offer good visual quality, preserve the ocular surface integrity and provide the patient with similar symptomatology levels after 15 days of lens wear.     

The effects of breaks on digital eye strain,dry eye and binocular vision: Testing the 20-20-20 rule

PurposeTo evaluate the benefits on the eyes of taking breaks based on the 20-20-20 rule.MethodsBespoke computer software using the laptop webcam to assess user breaks, eye gaze and blinking, and emitting personalized reminders of breaks based on the 20-20-20 rule, was downloaded onto the laptops of 29 symptomatic computer users. Digital eye strain (DES), binocular vision and dry eye were assessed before and after two weeks of using the reminders and one week after the discontinuation of the strategy. Binocular measurements included visual acuity, accommodative posture, stereopsis, fixation disparity, ocular alignment, accommodative facility, positive/negative vergences and near point of convergence. Symptoms were evaluated using the computer vision syndrome questionnaire, ocular surface disease index (OSDI), and symptom assessment in dry eye questionnaire (SANDE) versions one and two. Dry eye signs were assessed by measuring tear meniscus height, conjunctival redness, blink rate and incomplete blinking, lipid layer thickness, non-invasive keratograph break-up time, corneal and conjunctival staining and lid wiper epitheliopathy.ResultsA decrease in the duration of computer work and the duration of breaks, along with an increase in the number of breaks taken per day was observed as a result of the 20-20-20 rule reminders (p ≤ 0.015). No changes on any binocular parameter were observed after the management period (p ≥ 0.051), except for an increase in accommodative facility (p = 0.010). Dry eye symptoms and DES decreased with the rule reminders (p ≤ 0.045), although this improvement was not maintained one week after discontinuation (p > 0.05). No changes on any ocular surface and tear film parameter were observed with the rule reminders (p ≥ 0.089).ConclusionsThe 20-20-20 rule is an effective strategy for reducing DES and dry eye symptoms, although 2 weeks was not enough to considerably improve binocular vision or dry eye signs.     

Modifiable lifestyle risk factors for dry eye disease

PurposeTo examine the association between modifiable lifestyle factors and dry eye disease.MethodsThree hundred and twenty-two community residents (186 females, 136 males; mean ± SD age, 41 ± 22 years) with no major systemic or ophthalmic conditions (other than dry eye disease) were recruited in a cross-sectional study. A lifestyle factor questionnaire was administered, and dry eye symptomology, ocular surface characteristics, and tear film quality were evaluated for each participant within a single clinical session, in accordance with the global consensus recommendations of the TFOS DEWS II reports.ResultsA total of 111 (34 %) participants fulfilled the TFOS DEWS II diagnostic criteria for dry eye disease. Multivariate regression analysis demonstrated that advancing age, female sex, East Asian ethnicity, and increased digital screen exposure time were positive risk factors for dry eye disease (all p < 0.05), while increased caffeine consumption was a protective factor (p = 0.04).ConclusionsIncreased digital screen exposure time and reduced caffeine consumption were modifiable lifestyle factors associated with higher odds of dry eye disease. These findings might contribute to informing the design of future prospective research investigating the efficacy of preventative intervention and risk factor modification strategies.     

Attitudes of eye health practitioners towards diagnostic tests and therapies for dry eye disease in Australasia

IntroductionThe diagnosis of dry eye is challenging for eye health practitioners (EHP) and recently, a variety of new diagnostic tests have emerged. This study assesses the attitudes of EHP to dry eye and testing and compares these with attitudes in 2003.MethodsAn electronic questionnaire was disseminated to EHP in Australasia between December 2020 to March 2021. Participants rated the likelihood that presenting symptoms/signs were associated with dry eye, the utility of diagnostic tests, the value of test characteristics, and their satisfaction with dry eye diagnostics. Qualitative responses were categorised into positive, negative, or neutral themes.Results144 responses were received, with 117 (81.3%) from Australia and 27 (18.7%) from New Zealand. Posterior blepharitis was significantly more likely to be associated with dry eye than other factors (p < 0.01). Clinical history, fluorescein staining and FBUT were judged significantly more useful in diagnosing dry eye compared to other tests (p < 0.01). Test validity was judged significantly more important in choosing a test than other qualities. Qualitative attitudes towards dry eye presentations and diagnostic tests were positive in 42.2% and 24.3%, negative in 32.4% and 41.9%, and neutral in 25.5% and 33.8% respectively.ConclusionsThe opinions of EHP regarding dry eye tests were variable, but most favour history and corneal staining for diagnosis. Patterns of responses were similar to that reported by Turner et al 16-years ago, however, there is a higher satisfaction with available tests and therapeutic options. There is a need to develop a consensus amongst real-world clinicians regarding an optimum diagnostic pathway for dry eye, particularly in relation to newer diagnostic tests.     

A cross-sectional study of non-modifiable and modifiable risk factors of dry eye disease states

PurposeThe present study aimed to determine the relationship of non-modifiable (rheumatoid arthritis, thyroid diseases, and arterial hypertension) and modifiable risk factors (diuretics, antidepressants, or anxiolytics tranquilizers) with the different Dry Eye Disease (DED) diagnostics in a sample adjusted by antihistamines intake.MethodsA total of 400 participants were included in a cross-sectional study. Before a dry eye examination, participants completed an online self-administered OSDI questionnaire with six additional questions about possible DED risk factors. The Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS-II) diagnostic criteria of DED was used. Based on signs and/or symptoms, participants were divided into 4 groups: No DED, Pre-clinical DED, Predisposition to DED and DED. Since the symptom scores would have been altered by the use of antihistamines, the analysis of each outcome was adjusted for this factor, where those participants were assumed to be symptomatic.ResultsMultivariable logistic regression found thyroid disease as a possible risk factor for DED (OR 4.53, 95 % CI 1.04–19.73; Fisher’s exact, p = 0.044; Crameŕs V = 0.140, p = 0.024). No association was found between the studied parameters and Pre-clinical DED (Fisher’s exact, all p ≥ 0.398; Crameŕs V, all p ≥ 0.242) or Predisposition to DED (Fisher’s exact, all p ≥ 0.065; Crameŕs V, all p ≥ 0.031).ConclusionParticipants with thyroid disease were more likely to develop DED, therefore, thyroid disease could be a risk factor for DED.     

Clinical subtypes of dry eye in youthful clinical sample in Ghana

PurposeTo evaluate in a cohort of patients with dry eye disease (DED) the distribution of patients with asymptomatic and symptomatic dry eye involving aqueous deficient or the evaporative subtype of DED.MethodsThis was a clinic-based cross-sectional study of consecutive patients visiting the University of Cape Coast eye clinic for a comprehensive eye examination. Eligible participants completed the Ocular Surface Disease Index (OSDI), ocular surface staining and tear break up time. Subjects with dry eye (symptomatic or asymptomatic) underwent clinical examination comprising lid margin assessments, meibomian gland expressibility and quality assessments, and Schirmer 1 test.ResultsA total of 172 patients were included in the study. The mean age of the eligible participants was 22.7 (±3.7) years, with a range of 17–35 years. There were 83 males and 89 females in the sample. There was an association between the form of the dry eye whether symptomatic or asymptomatic and sex, (X² = 6.51 df = 1 p = 0.011). The frequency of symptomatic aqueous-deficient dry eye was 9(5.2%) whiles that of the symptomatic evaporative dry eye was 20(11.6%). The frequencies of the asymptomatic aqueous-deficient dry eye and asymptomatic evaporative dry eye were 9(5.2%) and 12(7.0%) respectively. The frequency of symptomatic mixed dry eye was 30(17.4%) and the asymptomatic mixed dry eye was 8(4.7%). The distribution of unclassifiable dry eye among the symptomatic dry eye group was 41(23.8%) and 43(25%) among the asymptomatic dry eye group.ConclusionThe number of patients exhibiting signs of the evaporative dry eye resulting from meibomian gland dysfunction far outnumbers those of aqueous deficient dry eye but there remains a high unclassifiable group with an unknown etiology. Further, studies are needed to explore the other etiology or etiologies of dry eye apart from meibomian gland dysfunction and reduced aqueous production.