Impact of Clinician Subjectivity on the Assessment of Dry Eye Disease Prevalence in a UK Public Health Care Patient Population
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, M...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2024-03-01
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| Series: | Clinical Ophthalmology |
| Subjects: | |
| Online Access: | https://www.dovepress.com/impact-of-clinician-subjectivity-on-the-assessment-of-dry-eye-disease--peer-reviewed-fulltext-article-OPTH |
| _version_ | 1797266503057276928 |
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| author | Sullivan BD Smith GT Gupta A Harman F Ansari E |
| author_facet | Sullivan BD Smith GT Gupta A Harman F Ansari E |
| author_sort | Sullivan BD |
| collection | DOAJ |
| description | 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 bdsulliv@trukera.comPurpose: 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 (< 10s) ranged from 39.1% to 61.6% (mean = 10.4 ± 6.6 seconds), osmolarity (> 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 |
| first_indexed | 2024-04-25T01:01:43Z |
| format | Article |
| id | doaj.art-7fea2af030b0447b9ae9c912386fbf70 |
| institution | Directory Open Access Journal |
| issn | 1177-5483 |
| language | English |
| last_indexed | 2024-04-25T01:01:43Z |
| publishDate | 2024-03-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Clinical Ophthalmology |
| spelling | doaj.art-7fea2af030b0447b9ae9c912386fbf702024-03-10T16:38:18ZengDove Medical PressClinical Ophthalmology1177-54832024-03-01Volume 1874375391075Impact of Clinician Subjectivity on the Assessment of Dry Eye Disease Prevalence in a UK Public Health Care Patient PopulationSullivan BDSmith GTGupta AHarman FAnsari EBenjamin 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 bdsulliv@trukera.comPurpose: 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 (< 10s) ranged from 39.1% to 61.6% (mean = 10.4 ± 6.6 seconds), osmolarity (> 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, hyperosmolarityhttps://www.dovepress.com/impact-of-clinician-subjectivity-on-the-assessment-of-dry-eye-disease--peer-reviewed-fulltext-article-OPTHcorneal fluorescein stainingdry eye diseasemeibomian gland diseasetear osmolarityhyperosmolarity |
| spellingShingle | Sullivan BD Smith GT Gupta A Harman F Ansari E Impact of Clinician Subjectivity on the Assessment of Dry Eye Disease Prevalence in a UK Public Health Care Patient Population Clinical Ophthalmology corneal fluorescein staining dry eye disease meibomian gland disease tear osmolarity hyperosmolarity |
| title | Impact of Clinician Subjectivity on the Assessment of Dry Eye Disease Prevalence in a UK Public Health Care Patient Population |
| title_full | Impact of Clinician Subjectivity on the Assessment of Dry Eye Disease Prevalence in a UK Public Health Care Patient Population |
| title_fullStr | Impact of Clinician Subjectivity on the Assessment of Dry Eye Disease Prevalence in a UK Public Health Care Patient Population |
| title_full_unstemmed | Impact of Clinician Subjectivity on the Assessment of Dry Eye Disease Prevalence in a UK Public Health Care Patient Population |
| title_short | Impact of Clinician Subjectivity on the Assessment of Dry Eye Disease Prevalence in a UK Public Health Care Patient Population |
| title_sort | impact of clinician subjectivity on the assessment of dry eye disease prevalence in a uk public health care patient population |
| topic | corneal fluorescein staining dry eye disease meibomian gland disease tear osmolarity hyperosmolarity |
| url | https://www.dovepress.com/impact-of-clinician-subjectivity-on-the-assessment-of-dry-eye-disease--peer-reviewed-fulltext-article-OPTH |
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