Correlation Among Dry Eye Questionnaires In Patients Without And With Glaucoma With Different Stages Of Severity

Glaucoma patients frequently suffer from dry eye disease (DED) and recent evidence suggest that management of ocular surface disease may play a role in management of glaucoma. The Ocular Surface Disease Index (OSDI) is the most frequently used questionnaire to assess DED symptoms, however its performance in glaucoma has theoretically been considered low. The aim of this study was to test the correlation among different DED questionnaires in patients without and with glaucoma with different severity stages.

University Hospital of Rome Tor Vergata, Rome, Italy

Cross-sectional study on consecutive patients attending the glaucoma clinic at the University Hospital of Rome Tor Vergata. Patients scheduled for visual field (VF), with reliable VFs and best corrected visual acuity (BCVA)0.3LogMAR in the better eye were included. The OSDI, 5-Item Dry Eye Questionnaire (DEQ-5) and Symptoms Assessment in Dry Eye (SANDE) were filled in. According to VF, patients were divided in no glaucoma (e.g. family history, ocular hypertension), mild VF defect(MD>-6dB), moderate VF defect(-6dB<MD>-12dB) and advanced glaucoma(MD<-12dB). Spearman correlation coefficient was used to test pairwise correlation between DED questionnaires in each group.

79 patients with mean age of 65.7±13.4 years were included. Mean BCVA was 0.2±0.5logMAR and mean MD was -6.1±6.4dB, with 27% of patients with no glaucoma(n=21), 33% with mild VF defect(n=26), 28% moderate (n=22) and 13% advanced (n=10). According to OSDI, 71% had DED symptoms, compared to 56% with the DEQ-5(p<0.001). OSDI showed good correlation with DEQ-5 and SANDE in patients with no glaucoma or mild-to-moderate VF damage(OSDI&DEQ-5: r’>0.6; p<0.003 and OSDI&SANDE: r’>0.45; p<0.02); while low correlation in advanced glaucoma (r’:0.22; p=0.54 and r’:0.30; p=0.39 with DEQ-5 and SANDE respectively). Conversely, DEQ-5 and SANDE always showed good and significant correlation, irrespective to the level of VF damage (always r'>0.65; p<0.01).

Our results show higher prevalence of DED symptoms being detected with the OSDI compared to the DEQ-5 in glaucoma patients. Additionally, the OSDI questionnaire has low correlation with both the DEQ-5 and SANDE in advanced glaucoma stages. Overall, our results discourage the use of the OSDI questionnaire in clinical practice and clinical studies involving glaucoma patients.