International survey on dry eye diagnosis by experts

Cristian Cartes; Christian Segovia; Margarita Calonge; Francisco C Figueiredo

doi:10.1016/j.heliyon.2023.e16995

International survey on dry eye diagnosis by experts

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

Authors

Cristian Cartes^{1

2}, Christian Segovia³, Margarita Calonge⁴, Francisco C Figueiredo^{5

6}

Affiliations

¹ Unidad Oftalmología, Departamento de Especialidades, Facultad de Medicina, Universidad de la Frontera, Temuco, Chile.
² Centro de la Visión, Red Centro Oftalmológico Laser, Santiago, Chile.
³ Departamento de Tecnología Médica, Facultad de Ciencias de la Salud. Universidad Católica del Maule, Talca, Chile.
⁴ OBA (Institute of Applied Ophthalmobiology), CIBER-BBN, University of Valladolid, 47011, Valladolid, Spain.
⁵ Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
⁶ Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK.

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.