Utilizing visual symptoms to distinguish dry eye from glaucoma, cataract, and suspect glaucoma patients: a cross-sectional study

David X Zhao; Michael Quintero; Aleksandra Mihailovic; Esen Akpek; Sezen Karakus; Lee Guo; Pradeep Y Ramulu

doi:10.1186/s12886-023-03219-2

Utilizing visual symptoms to distinguish dry eye from glaucoma, cataract, and suspect glaucoma patients: a cross-sectional study

BMC Ophthalmol. 2024 Jan 9;24(1):16. doi: 10.1186/s12886-023-03219-2.

Authors

David X Zhao¹, Michael Quintero¹, Aleksandra Mihailovic¹, Esen Akpek¹, Sezen Karakus¹, Lee Guo¹, Pradeep Y Ramulu^{2

3}

Affiliations

¹ Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA.
² Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA. pramulu@jhmi.edu.
³ Wilmer Eye Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe St., Wilmer 129, Baltimore, MD, 21287, USA. pramulu@jhmi.edu.

Abstract

Background: The diagnosis of dry eye and other common ophthalmological conditions can be supported using patient reported symptoms, which is increasingly useful in contexts such as telemedicine. We aim to ascertain visual symptoms that differentiate dry eye from cataract, glaucoma, or glaucoma suspects.

Methods: Adults with dry eye, glaucoma, cataract, and suspected glaucoma (controls) completed a questionnaire to rate the frequency and severity of 28 visual symptoms. Univariate, followed by multivariable logistic regression with backward stepwise selection (p < 0.05), determined the individual symptoms and set of symptoms best distinguishing dry eye from each of the other conditions.

Results: Mean age of 353 patients (94 glaucoma suspect controls, 79 glaucoma, 84 cataract, and 96 dry eye) was 64.1 years (SD = 14.1); 67% were female and 68% White. Dry eye patients reported more frequent light sensitivity (OR = 15.0, 95% CI = 6.3-35.7) and spots in vision (OR = 2.8, 95% CI = 1.2-6.3) compared to glaucoma suspect controls. Compared to glaucoma patients, dry eye patients experienced more frequent light sensitivity (OR = 9.2, 95% CI = 2.0-41.7), but less frequent poor peripheral vision (OR = 0.2, 95% CI = 0.06-0.7), difference in vision between eyes (OR = 0.09, 95% CI = 0.01-0.7), and missing patches of vision (OR = 0.06, 95% CI = 0.009-0.3). Compared to cataract patients, dry eye patients reported more frequent spots in vision (OR = 4.5, 95% CI = 1.5-13.4) and vision variability across the week (OR = 4.7, 95% CI = 1.2-17.7) and were less likely to report worsening vision (OR = 0.1, 95% CI = 0.03-0.4) and blindness (OR = 0.1, 95% CI = 0.02-0.8).

Conclusion: Visual symptoms may serve as a complementary tool to distinguish dry eye from various ocular conditions, though the symptoms that best distinguish dry eye differ across comparisons. Differentiating how patients visually perceive common eye diseases may be used in a variety of clinical settings to rule out specific conditions.

Keywords: Cataract; Dry eye; Glaucoma; Visual symptoms.

MeSH terms

Adult
Cataract* / complications
Cataract* / diagnosis
Cross-Sectional Studies
Dry Eye Syndromes* / diagnosis
Female
Glaucoma* / complications
Glaucoma* / diagnosis
Humans
Male
Ocular Hypertension*
Photophobia
Vision, Low*