학술논문

Impact of Clinician Subjectivity on the Assessment of Dry Eye Disease Prevalence in a UK Public Health Care Patient Population
Document Type
Academic Journal
Source
Clinical Ophthalmology. March 31, 2024, Vol. 18, p743, 11 p.
Subject
United Kingdom
Language
English
ISSN
1177-5483
Abstract
Purpose: To understand the impact of subjectivity on diagnosis rates of dry eye disease (DED) in an unbiased population. Patients and Methods: A multicenter study enrolled 818 subjects with complete report forms (465 females, 67.1 [+ or -] 16.7 years, 353 males, 65.0 [+ or -] 15.9 years). Subjects were evaluated for staining, TBUT, tear osmolarity, meibomian gland disease, and OSDI. Results: Physicians diagnosed 48.7% of subjects as having DED, ranging from 42.9% to 62.3% between sites. Positivity rates for staining ([greater than or equal to] grade 1) ranged from 41.3% to 84.1% (mean = 0.8 [+ or -] 0.9 grade), TBUT (308 mOsm/L) ranged from 63.7% to 72.4% (mean = 319.7 [+ or -] 20.8), MGD grading ranged from 28.9% to 51.3% (mean = 0.5 [+ or -] 0.7), and symptoms measured by OSDI ranged from 57.6% to 71.0% (mean = 23.5 [+ or -] 20.5) between sites. Tear osmolarity was the most consistent between sites (max/min positivity = 114%), followed by OSDI (123%), TBUT (158%), MGD (178%), and staining (204%). DED markers were uncorrelated (average [r.sup.2] = 0.05 [+ or -] 0.07). A substantial number of subjects (N = 110) exhibited positive symptoms (OSDI = 32.4 [+ or -] 15.7) and hyperosmolarity (338.1 [+ or -] 20.1 mOsm/L) but no other obvious signs of DED (MGD grade = 0.2 [+ or -] 0.4, TBUT = 13.5 [+ or -] 7.0 seconds, staining grade = 0.4 [+ or -] 0.5). Conclusion: Subjective signs of DED varied considerably, whereas objective measurements of OSDI and osmolarity were the most consistent between sites. A large proportion of subjects exhibited high symptoms and hyperosmolarity but no other obvious signs of dry eye disease, most of whom were undiagnosed by clinical assessment without access to the osmolarity measurement. Keywords: corneal fluorescein staining, dry eye disease, meibomian gland disease, tear osmolarity, hyperosmolarity
Introduction In the past decade since tear osmolarity has become more widely available in the clinic, there have been conflicting reports about the utility of the biomarker. There is broad [...]