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Mourad Amrane, Alexandre CIVET, Alexandre Templier, Dian Kang, Francisco C Figueiredo; Patients with Moderate to Severe Dry Eye Disease in Routine Clinical Practice in the UK - Physician and Patient’s Assessments. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4443.
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To identify and highlight differences and similarities of profiles of severe patients according to physician and patients.
This was a prospective, single-centre, registry of adults with moderate to severe KCS recruited from March 2002 to June 2009. No treatments were mandated as part of this study and patients were treated over time as in normal clinical practice. Clinical outcomes, medications used and severity assessment by the physician and patient were recorded at each routine clinic visit. Patient reported outcomes included the Dry Eye Disease Impact Questionnaire (DEDIQ). Data analysis was performed by Quinten using its proprietary supervised learning algorithm (Q-Finder) to identify and characterize profiles of severe patients.
The study included 80 patients, among which 38% were classified as severe according to PhA (SPhA, from 7 to 9 on a 9-points scale), and 46% according to PaA (SPaA, same scale as PhA). Results show that severity according to physician is driven by Schirmer test lower than 1 - SPhA: 77%; SPaA: 53% - and Tear Function Index lower than 14 - SPhA: 71%; SPaA: 57% -, whereas severity according to patients is linked to combinations of subjective symptoms felt all of the time such as irritation - SPaA: 87%; SPhA: 40% -, discomfort - SPaA: 81%; SPhA: 37.5% - or grittiness - SPaA: 82%; SPhA: 47% -. However we identified two profiles reconciling these two views, essentially characterized by extreme use of artificial tears every day (more than 14 times a day) - SPaA: 83%; SPhA: 67% - or burning sensation at least most of the time - SPaA: 87%; SPhA: 60% -.
Current clinical outcomes evaluation criteria and methods seem to be not sufficient to objectively evaluate severity in KCS patients. Physicians should be more receptive to patients’ symptoms and ways to improve their quality of life beyond clinical signs. A composite score based on a combination of selected signs and symptoms might be built and validated on multiple cohorts.
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