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.

Standard Patient Evaluation

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 eight 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 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 analog 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."