Grading Dry Eye Severity: A Comparison of Clinician and Self-Assessment

Abstract

Abstract: : Purpose: This study compares the patient's self-assessment of dry eye to the clinician's global assessment of severity. Methods: 210 subjects from 6 ophthalmic practices in North America were recruited by dry eye diagnostic codes and a telephone interview querying frequency of eye dryness. Forty-eight (48) controls, 130 non-Sjogren's dry eye and 32 Sjogren's Syndrome subjects were recruited. Each subject gave a global rating of dry eye severity from "I don't have it" (0) to Extremely Severe (5), and after a series of dry eye clinical tests and discussion of symptoms, the clinician made a non-protocol driven global clinical assessment of dry eye from None (0) to Severe (4). Results: A comparison of the clinicians' severity (CS) with subjects' severity (SS) rating showed that among the subjects with a CS of None, 24% gave an SS rating of Mild to Moderate. Fifty-five percent (55%) of the subjects with a Mild CS rating reported a severity of Moderate or higher. Fifty percent (50%) of the subjects with a Moderate CS rated their condition as Severe. Although the clinician rating and subjects' self-assessment of dry eye were highly correlated (r=.780, p<0.0001), clinicians and subjects often disagreed, with 40% of the subjects reporting worse severity than the clinician. Conclusions: Even in a dry eye clinical study, subjects perceived dry eye as more severe than clinicians could detect. The lack of a 'gold standard' clinical test for dry eye limits the clinician's ability to objectively assess dry eye severity.

Keywords: cornea: tears/tear film/dry eye • clinical (human) or epidemiologic studies: pre • lacrimal gland