Dry Eye Risk Assessment (DERA): Predictive Value of Newly Identified Risk Factors

Abstract

Purpose : Risk factors for dry eye have largely been established but haven’t been updated recently. New risk factors were identified in previous work using multivariate regression: seeing a doctor regularly, sinus issues, migraines, and use of eye drops. This dry eye risk assessment (DERA) instrument was then tested in an independent sample to see the degree of agreement between investigator opinion to the output and cut point of the model.

Methods : DERA and the dry eye questionnaire (DEQ-5) were administered to patients at 11 clinical sites. Each investigator was masked to those initial responses and allowed to choose at minimum one clinical test to qualify the subject as dry or normal using established cut points: tear break up time, Efron corneal or conjunctival staining, meibomian gland expression quality, phenol red thread test. The DEQ-5 cut point of > 6 and DERA cut point of > 0.61 was used. Subjects were then classified according to the DEWS II definitions as normal, dry eye disease, signs without symptoms (predisposition), or symptoms without signs (preclinical). Descriptive statistics included proportions.

Results : There were 87 subjects with an average age of 50.7±18.1 years. There was 72.8% agreement between investigator opinion and DERA. When symptoms per DEQ-5 and at least one sign were used, agreement between that diagnosis and DERA was 76.2%. DEQ-5 responses revealed: 22 normal, 38 with a score ≥ 6 and < 12, and 27 with a score ≥ 12. According to the DEWS II classification, there were: 10 normal, 64 dry eye disease, 9 predisposition, 1 preclinical. In this sample, DERA identified 71 subjects at risk.

Conclusions : According to previous work done by Chalmers et al in regards to DEQ-5, 30.3% of this sample is suspicious for Sjogren’s Syndrome Dry Eye. DERA, as a standalone instrument largely based on a few items of health history, is able to accurately identify patients at risk for dry eye close to its previously established sensitivity (87%) and specificity (74%).

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.