Korean guidelines for the diagnosis and management of dry eye: development and validation of clinical efficacy

Abstract

Purpose: To evaluate the clinical efficacy of newly developed guidelines for the diagnosis and management of dry eye.

Methods: This retrospective, multi-center, non-randomized, observational study included a total of 1,612 patients with dry eye disease who initially visited the clinics from March 2010 to August 2010. Korean guidelines for the diagnosis and management of dry eye were newly developed from concise, expert-consensus recommendations. Severity levels at initial and final visits were determined using the guidelines in patients with 90 ± 7 days of follow-up visits (n = 526). Groups with different clinical outcomes were compared with respect to clinical parameters, treatment modalities, and guideline compliance. Main outcome measures were ocular and visual symptoms, ocular surface disease index, global assessment by patient and physician, tear film break-up time, Schirmer-1 test score, ocular surface staining score at initial and final visits, clinical outcome after three months of treatment, and guideline compliance.

Results: Severity level was reduced in 47.37% of patients treated as recommended by the guidelines. Younger age (odd ratio [OR], 0.984; p = 0.044), higher severity level at initial visit, compliance to treatment recommendation (OR, 1.832; p = 0.047), and use of topical cyclosporine (OR, 1.838; p = 0.011) were significantly associated with improved clinical outcomes.

Conclusions: Korean guidelines for the diagnosis and management of dry eye can be used as a valid and effective tool for the treatment of dry eye disease.

Keywords: Dry eye syndrome; Practice guideline; Standards.

Fig. 1

Distribution of severity level of dry eye (DE) disease at the initial visit (n = 1,612) (Korean Corneal Disease Study Group guidelines).

Fig. 2

Severity level of dry eye disease at the initial and final visits (n = 526) (Korean Corneal Disease Study Group guidelines).

Fig. 3

Changes of subjective (A-D) and objective (E-H) clinical parameters in dry eye patients (n = 526) of each initial severity level (Korean Corneal Disease Study Group guidelines). (A) Ocular surface disease index (%), (B) irritation and visual symptoms (1, sometimes; 2, often; 3, always; 4, daily life limited), (C) visual symptom, (D) subjective global assessment (0 [best] to 5 [worst]), (E) tear film break up time (sec), (F) Schirmer-1 test score (mm/5 min), (G) ocular surface staining score (Oxford scale), (H) objective global assessment (0 [best] to 5 [worst]).