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J. G. Walt, V. D. Patel, K. M. Fox, M. Schwartz, A. Dubey; Agreement between Physician and Patient in Reported Severity of Dry Eye Disease. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6246.
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Dry eye disease, a common tear film disorder, is characterized by inflammation of the ocular surface and lacrimal glands. It presents as ocular discomfort, visual impairment, persistent dryness, and burning. Existing evidence suggests that symptoms of dry eye may exist without evidence of ocular surface damage. This research was conducted to further evaluate how well do physician and patient reported severity of dry eye correlate.
Baseline data from RESTORE-large, multi-center, observational study of dry eye patients seeking ophthalmologists care, were analyzed. Percent correlations between the physician-reported severity of sign and symptoms and patient reported severity of symptoms/activity limitations were computed. Physicians assessed severity using Schirmer’s test and symptoms of ocular discomfort, ocular fatigue, and visual disturbance. Patients assessed severity using the Ocular Surface Disease Index (OSDI)). The OSDI is a 12-item, self-administered questionnaire for rapid assessment of symptoms of dry eye disease.
Total of 766 patients visiting their physician office with chief complaint of dry eye were enrolled at 40 sites. Mean age was 61 years, 80% were women, and 88% were Caucasian. Based on OSDI scores, 179 (23%) patients rated their severity of dry eye disease as mild, 176 (23%) as moderate, and 411(54%) as severe. Disease severity as rated by the Schirmer test differed significantly from OSDI severity (p = 0.001); percent agreement = 28%. Fewer patients with severe OSDI score were rated severe on the Schirmer’s test (OS=19.5% and OD=21.9%) Physician-reported severity of symptoms differed significantly from OSDI severity for ocular discomfort, ocular fatigue, and visual disturbance (p < 0.001for each). Percent agreement between physician-reported severity and OSDI was 32% for ocular discomfort, 27% for ocular fatigue, and 24% for visual disturbance.
Given the fact that there is poor agreement between objective clinical measures of dry eye and patient symptoms, it is important to assess both signs and symptoms when evaluating dry eye severity.
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