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Jeffry Hogg, Dahlia Ismail, Jean-Sebastien Garrigue, Maëva Deniaud, Mourad Amrane, Francisco C Figueiredo; A longitudinal study of the relationship between signs and symptoms in keratoconjunctivitis sicca. Invest. Ophthalmol. Vis. Sci. 2018;59(9):934.
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© ARVO (1962-2015); The Authors (2016-present)
The reported prevalence of Keratoconjunctivitis sicca (KCS) in the adult population ranges between 5% and 33%. The symptoms these patients report have been shown to only weakly correlate to clinical signs but few studies consider all measures of KCS signs and symptoms in a single cohort of patients. The purpose was to establish which measures of symptomatology and which clinical signs offer the strongest correlation between clinician assessment and patient experience of KCS.
25 KCS patients (mean age 64, 22 females) were recruited from a tertiary KCS clinic In Newcastle upon Tyne, UK. Each participant completed the Ocular Surface Disease Index (OSDI), Ocular Comfort Index (OCI) and Dry Eye-related Quality of life Score (DEQS, -S for symptoms and –I for impact) questionnaires. In addition patients’ ocular surfaces were assessed with fluorescein (FS) and lissamine green (LGS) stains, tear break-up time (TBUT), Schirmer’s test and tear osmolality. 15 patients had a repeat appointment a mean of 12.7 months (SD 1.4 months) later where the same data were collected. Data were analysed to identify where the strongest correlations between signs and symptoms in the worse eye exist when considering both individual patients and the whole cohort over time using a matrix of Spearman correlations.
The questionnaires showed high correlations between them, the greatest being DEQS impact dimension with OCI (c=0.77, p<0.0001), and OSDI with OCI (c=0.60, p=0.0023).Regarding signs, a significant correlation was observed between conjunctival ( LGS) and corneal (FS) measures (c=0.57, p=0.0138) and a negative correlation was observed between TBUT and LGS measure of conjunctival score (c= - 0.52, p=0.0323). Correlations between OCI and corneal FS, between OSDI and conjunctival LGS and between DEQS-S and corneal FS were also relatively high and significant at baseline (c=0.43, p=0.0363; c=0.48, p=0.0463 and c=0.36, p=0.0822 respectively).Longitudinal data showed similar findings, with some correlations even greater.
In clinical research on KCS, the lack of correlations between symptoms and signs often observed makes data interpretation somewhat complicated. This study has showed a correlation between clinical signs and symptoms questionnaires with a more pronounced correlation observed between OCI and corneal FS and between OSDI and conjunctival LGS.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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