July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Dry Eye Risk Assessment (DERA): Predictive Value of Newly Identified Risk Factors
Author Affiliations & Notes
  • Justin Kwan
    Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, United States
  • Jennifer S Harthan
    Illinois College of Optometry, Chicago, Illinois, United States
  • Tracy Doll
    College of Optometry, Pacific University, Forest Grove, Oregon, United States
  • Scott Schwartz
    Dr. Schwartz Optometrist and Associates, Sterling Heights, Michigan, United States
  • Clare Halleran
    East Coast EyeCare, Clarenville, Newfoundland, Canada
  • Scott G Hauswirth
    University of Colorado, Denver, Colorado, United States
  • Leslie E O'Dell
    Mechanicsburg Eye Associates, Mechanicsburg, Pennsylvania, United States
    Wheatlyn EyeCare, Manchester, Pennsylvania, United States
  • Scott Schachter
    Advanced Eyecare and The Eyewear Gallery, Pismo Beach, California, United States
  • Katherine Mastrota
    New York Hotel Trade Council / The Hotel Association of New York City Employee Benefits Fund, Health Center, Inc., New York, New York, United States
  • Nathalie Bernabe
    Private Practice, Azusa, California, United States
  • Milton M Hom
    Private Practice, Azusa, California, United States
  • Footnotes
    Commercial Relationships   Justin Kwan, Johnson & Johnson Vision (F), Johnson & Johnson Vision (C), Johnson & Johnson Vision (R), Visioneering Technologies Inc (R); Jennifer Harthan, Allergan (C), Metro Optics (R), Metro Optics (C), Shire (C), Tangible Science (R), Valeant (C); Tracy Doll, Allergan (C), Shire (C); Scott Schwartz, None; Clare Halleran, Allergan (C), Shire Canada (C); Scott Hauswirth, Allergan (C), Avedro (C), BioTissue (C), BioTissue (F), Glaukos (C), Mentholatum (F), Shire (C), Sun Ophthalmics (C); Leslie O'Dell, Aerie (C), Alcon (R), Allergan (C), Eye Eco (C), Johnson & Johnson Vision (R), Paragon Biotech (C), Quidel (C), Shire (C); Scott Schachter, Allergan (C), Bausch + Lomb (C), BioTissue (C), Box Medical Solutions (C), Quidel (C), Science Based Health (C); Katherine Mastrota, Allergan (C), Bausch + Lomb (C), BioTissue (R), OCuSOFT (R), Paragon Biotek (C), Science Based Health (C), Shire (C), TearLab (I); Nathalie Bernabe, None; Milton Hom, Allergan (C), Allergan (F), Bausch + Lomb (C), Kala (F), Shire (C), Shire (F), Sun Ophthalmics (C)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 4861. doi:
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    • Get Citation

      Justin Kwan, Jennifer S Harthan, Tracy Doll, Scott Schwartz, Clare Halleran, Scott G Hauswirth, Leslie E O'Dell, Scott Schachter, Katherine Mastrota, Nathalie Bernabe, Milton M Hom; Dry Eye Risk Assessment (DERA): Predictive Value of Newly Identified Risk Factors. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4861.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.


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