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. 2023 Jun 7;9(6):e16995.
doi: 10.1016/j.heliyon.2023.e16995. eCollection 2023 Jun.

International survey on dry eye diagnosis by experts

Cristian Cartes  1   2 , Christian Segovia  3 , Margarita Calonge  4 , Francisco C Figueiredo  5   6
Affiliations

International survey on dry eye diagnosis by experts

Cristian Cartes et al. Heliyon. .

Abstract

Purpose: To evaluate patterns and opinion from international experts with respect to dry eye disease (DED) diagnosis in clinical practice.

Methods: An online survey was distributed to worldwide DED experts. The use of diagnosis tests was evaluated including: symptoms questionnaires, functional tests, tear stability, tear volume, tear composition, surface damage and inflammation, and eyelid assessment. After the subjective importance of symptoms, tear break up time (TBUT), non-invasive TBUT, Schirmer's test, tear meniscus height, tear osmolarity, tear metalloproteinase 9, blepharitis assessment and non-contact meibography was evaluated according to likert scale.

Results: The survey was sent to 109 experts, and 77 completed the questionnaire (rate of response = 70.6%). Most of the participants were from North America (27%) and Europe (40%). A majority of respondents (73%) diagnose DED using clinical signs and symptoms, but not fulfilling a specific criteria. Seventy-six participants (98.7%) use symptoms questionnaires. All participants evaluate damage to ocular surface, and fluorescein staining is the most frequent method used (92%). Also, all the respondents perform meibomian gland and blepharitis assessment. On the other hand, only 69.8% evaluate tear composition, being osmolarity the most common test used (66.2%). Regarding to the importance of tests, TBUT (p = 0.002) and Schirmer's (p = 0.021) were found to be more important to experts from Europe than North America. No differences were found in any other test (p > 0.05).

Conclusions: This survey offers updated and day-to-day diagnostic clinical practice by DED worldwide experts. The results highlight the importance of symptoms and clinical signs, but not necessarily following a strict criteria.

Keywords: Diagnosis; Dry eye disease; Expert survey; Symptoms questionnaires.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Respondents place of practice.
Fig. 2
Fig. 2
Main preferences to evaluate dry eye disease according to each category*. * = Multiple answers were allowed for each category, OSDI= Ocular Surface Disease Index, DEQ-5 = Dry Eye Questionnaire-5, SPEED= Standard Patient Evaluation of Eye Dryness Questionnaire, IDEEL= Impact of Dry Eye in Everyday Life, FVA=Functioal Visual Acuity, OQAS = , TBUT = tear break up time, NITBUT = non invasive tear break up time, TMH: tear meniscus height, TMA = tear meniscus area, LIPCOF= Lid Parallel Conjunctival Folds, MMP-9 = matrix metalloproteinases, HLA-DR = human leucocyte antigen.
Fig. 3
Fig. 3
Subjective importance of the different dry eye disease diagnosis tests. MMP-9 = matrix metalloproteinases.
Fig. 4
Fig. 4
Comparison between experts from Europe and North America with respect to dry eye disease diagnostic tests. * = statistically significant, MMP-9 = matrix metalloproteinases.
See this image and copyright information in PMC

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