Rasch analysis of three dry eye questionnaires and correlates with objective clinical tests

Colm McAlinden; Rongrong Gao; Qinmei Wang; Senmiao Zhu; Jing Yang; Ayong Yu; Anthony J Bron; Jinhai Huang

doi:10.1016/j.jtos.2017.01.005

Rasch analysis of three dry eye questionnaires and correlates with objective clinical tests

Ocul Surf. 2017 Apr;15(2):202-210. doi: 10.1016/j.jtos.2017.01.005. Epub 2017 Feb 4.

Authors

Colm McAlinden¹, Rongrong Gao², Qinmei Wang³, Senmiao Zhu⁴, Jing Yang⁴, Ayong Yu², Anthony J Bron⁵, Jinhai Huang⁶

Affiliations

¹ School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; ABM University Health Board, Swansea, UK; University Hospitals Bristol, NHS Foundation Trust, Bristol, UK; Flinders University, Adelaide, South Australia, Australia.
² School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
³ School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China. Electronic address: wqm6@mail.eye.ac.cn.
⁴ School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
⁵ Nuffield Department of Clinical Neurosciences and Nuffield Laboratory of Ophthalmology, University of Oxford, UK; Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK.
⁶ School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China. Electronic address: vip999vip@163.com.

PMID: 28179131
DOI: 10.1016/j.jtos.2017.01.005

Abstract

Purpose: To assess the psychometric properties of Chinese versions of the Ocular Comfort Index (OCI), Ocular Surface Disease Index (OSDI) and McMonnies questionnaires. Further, to assess the correlation between questionnaire scores and objective dry eye disease (DED) clinical tests.

Methods: Translated versions of the OCI, OSDI and McMonnies questionnaires were completed in a random order by 238 participants with DED. Objective clinical tests included visual acuity (VA), fluorescein tear film break-up time (TBUT), corneal fluorescein staining, Schirmer I testing and meibomian gland grading. Rasch analysis was used to assess questionnaire psychometrics and spearman rank for correlations.

Results: For the OCI, the person separation was 2.31, item infit and outfit statistics ranged from 0.74-1.14 and 0.75-1.32, respectively, and targeting 1.54 logits. For the OSDI, person separation was 0.94. None of the three subscales provided valid measurements based on Rasch analysis. For the McMonnies questionnaire, person separation was 1.17, item infit and outfit statistics ranged from 0.7 to 1.21 and 0.51-3.49, respectively. There were weak correlations between questionnaire scores and clinical tests. There were weak correlations between OSDI scores and VA, fluorescein TBUT, Schirmer I testing and corneal fluorescein staining. There were weak correlations between McMonnies scores and VA, fluorescein TBUT, Schirmer I testing, and corneal fluorescein staining and meibomian gland grading.

Conclusions: The OCI questionnaire was the only questionnaire that provided valid measurement on the basis of Rasch analysis, although slight multidimensionality was found. There were weak correlations between OCI scores and fluorescein TBUT, Schirmer I testing, and corneal fluorescein staining. Due to this paradoxical disconnect between symptoms and signs and the repeatability of tests, the use of both subjective and objective markers in the clinical management of patients or as endpoints in clinical trials would appear prudent.

Keywords: Dry eye; Ocular Comfort Index; Ocular Surface Disease Index; Questionnaires; Rasch analysis.

MeSH terms

Dry Eye Syndromes*
Humans
Keratoconjunctivitis Sicca
Meibomian Glands
Psychometrics
Surveys and Questionnaires
Tears