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Ngozi Charity Chidi-Egboka, Blanka Golebiowski, Sun-Young Lee, Mimi Vi, Isabelle Jalbert; Dry eye symptoms in children: Can we reliably measure them?. Invest. Ophthalmol. Vis. Sci. 2020;61(7):121.
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© ARVO (1962-2015); The Authors (2016-present)
Ocular surface symptoms are reported to be lower in children in comparison to adults, but most studies used questionnaires developed for and validated in adult populations. This study measured repeatability and examined feasibility of using validated adult dry eye symptoms questionnaires in children.
Sixty children aged 6-15 years (10.1±2.6 years; 23M:37F) with healthy eyes completed 6 questionnaires twice in random order at one visit: Symptoms Assessment in Dry Eye (SANDE), Ocular Surface Disease Index (OSDI), Numerical Rating Scale (NRS), Ocular Comfort Index (OCI, n=28), Dry Eye Questionnaire 5 (DEQ-5), Instant Ocular Symptoms Survey (IOSS). Completion time and need for assistance were recorded for each questionnaire, and relationships with age examined (Pearson correlation, independent t-test). The number of children requiring assistance and items proportion were compared between questionnaires (linear mixed model). Repeatability was examined using the Bland & Altman method (Coefficient of repeatability (CoR), Limit of agreement (LOA) and bias). Strength of reliability was examined using intraclass correlation coefficient (ICC).
Mean completion time was ≤ 2min for each questionnaire (Table 1); younger age was associated with longer completion time (r = -0.42 to -0.60, p≤0.01). 47 children required assistance with at least one questionnaire and were younger than children who did not require any assistance (p≤0.001). More children required assistance with the NRS than with the SANDE, OCI, DEQ-5 or IOSS (≤0.05 to p<0.0001). More children required assistance with SANDE and OSDI than with the DEQ-5 and IOSS (p≤0.04 to p≤0.004) (Table 1). Most assistance was needed with items gritty (OSDI, 77% of children; OCI, 100%) and foreign body sensation (NRS, 92%). CoR was similar for all questionnaires, with no evidence of a learning effect. ICC ranged from moderate to excellent.
Dry eye questionnaires can be administered in children with assistance. Repeatability of OSDI, NRS and OCI were worse than in adults. Specific terms may not be understood by children. More research is required to validate questionnaires’ ability to diagnose dry eye symptoms in children using symptomatic populations.
This is a 2020 ARVO Annual Meeting abstract.
Table 1: Questionnaire scores, completion time, assistance required, reliability and repeatability for 6 dry eye symptoms questionnaires administered to 60 children aged 6-15 years. NB: 28 children completed OCI.
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