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Joelle Hallak, Sarmad Jassim, Sandeep Jain; Symptom Burden of Patients with Dry Eye Disease: A Four Domain Analysis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):960.
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Intensity and affective interference are not measured by current standardized dry eye symptom questionnaires. We hypothesize that symptom burden of Dry Eye Disease (DED) is determined with greater accuracy when a 4 domain questionnaire, that measures symptom persistence, intensity, activity, as well as affective interference, is utilized.
The 4 domain DED symptom burden questionnaire was developed from well-established and validated symptom burden tools used in other chronic diseases, such as the MD Anderson tool that assesses pain in cancer patients. A pilot study was performed where the DED symptom burden questionnaire and the Ocular Surface Disease Index (OSDI) questionnaires were administered to 15 patients. A weighted item response analysis was performed for the symptom burden questionnaire (maximum persistence scores were multiplied with the intensity and average activity and affective scores were then added to compute a total symptom burden score). The OSDI (index) score was calculated from OSDI item responses. Tear production was measured by the schirmer test and correlated with the symptom burden score and the OSDI index score.
Results from the OSDI questionnaire showed more equal and comparable scores between patients with significantly different schirmer measurements than results from the symptom burden questionnaire. Two patients had OSDI scores of 27 with schirmer scores of 1 and 14, respectively. The symptom burden scores of these patients, however, differed 13 versus 34.43. A negative correlation was shown between symptom burden scores and schirmer scores whereas a positive correlation was shown between OSDI scores and schirmer test scores.
Intensity may be an essential domain to include in symptom questionnaires for DED, specifically when correlating reported symptoms with clinical signs. A complete analysis of dry eye symptom burden includes 4 domains (persistence and intensity of symptoms, and intereference with activity and affect).
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