Clinical Ophthalmology (Mar 2024)

Impact of Clinician Subjectivity on the Assessment of Dry Eye Disease Prevalence in a UK Public Health Care Patient Population

  • Sullivan BD,
  • Smith GT,
  • Gupta A,
  • Harman F,
  • Ansari E

Journal volume & issue
Vol. Volume 18
pp. 743 – 753

Abstract

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Benjamin D Sullivan,1 Guy T Smith,2 Arun Gupta,3 Francesca Harman,4 Ejaz Ansari5 1Trukera Medical, Southlake, TX, USA; 2The Great Western Hospital NHS Trust, Swindon, UK; 3Ashford and St Peters NHS Trust, Ashford, UK; 4Hillingdon Hospital NHS Foundation, Uxbridge, UK; 5Department of Ophthalmology, Maidstone & Tunbridge Wells Hospitals, Maidstone, Kent, UKCorrespondence: Benjamin D Sullivan, Email [email protected]: To understand the impact of subjectivity on diagnosis rates of dry eye disease (DED) in an unbiased population.Patients and Methods: A multicenter study enrolled 818 subjects with complete report forms (465 females, 67.1 ± 16.7 years, 353 males, 65.0 ± 15.9 years). Subjects were evaluated for staining, TBUT, tear osmolarity, meibomian gland disease, and OSDI.Results: Physicians diagnosed 48.7% of subjects as having DED, ranging from 42.9% to 62.3% between sites. Positivity rates for staining (≥ grade 1) ranged from 41.3% to 84.1% (mean = 0.8 ± 0.9 grade), TBUT ( 308 mOsm/L) ranged from 63.7% to 72.4% (mean = 319.7 ± 20.8), MGD grading ranged from 28.9% to 51.3% (mean = 0.5 ± 0.7), and symptoms measured by OSDI ranged from 57.6% to 71.0% (mean = 23.5 ± 20.5) between sites. Tear osmolarity was the most consistent between sites (max/min positivity = 114%), followed by OSDI (123%), TBUT (158%), MGD (178%), and staining (204%). DED markers were uncorrelated (average r2 = 0.05 ± 0.07). A substantial number of subjects (N = 110) exhibited positive symptoms (OSDI = 32.4 ± 15.7) and hyperosmolarity (338.1 ± 20.1 mOsm/L) but no other obvious signs of DED (MGD grade = 0.2 ± 0.4, TBUT = 13.5 ± 7.0 seconds, staining grade = 0.4 ± 0.5).Conclusion: Subjective signs of DED varied considerably, whereas objective measurements of OSDI and osmolarity were the most consistent between sites. A large proportion of subjects exhibited high symptoms and hyperosmolarity but no other obvious signs of dry eye disease, most of whom were undiagnosed by clinical assessment without access to the osmolarity measurement.Keywords: corneal fluorescein staining, dry eye disease, meibomian gland disease, tear osmolarity, hyperosmolarity

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