Validation of the Arabic version of the Ocular Surface Disease Index Questionnaire

Assessment of tear film parameters post-treatment with commercial eyelid cleaning wipes: a pilot study

AIM

To investigate the short-term effects of commercially available eyelid-cleaning wipes on film parameters.

METHODS

This study enrolled 48 healthy participants aged 20-35y (both males and females). Clinical assessment included the Ocular Surface Disease Index (OSDI) questionnaire, non-invasive tear break-up time (NITBUT), tear meniscus height (TMH), and lipid layer pattern (LLP). Based on these initial results, participants were categorized as either non-dry eye or dry eye. Participants in each group were randomly allocated to either Blephaclean® or Systane® treatments. Changes in NITBUT, TMH, and LLP levels before and after lid wipe treatment were assessed.

RESULTS

The dry eye group exhibited significantly higher OSDI scores and lower NITBUT and TMH levels than in the non-dry eye group (P<0.001). Following the application of eyelid wipes (Systane® wipes), dry eye subjects experienced a significant improvement in NITBUT levels (P=0.0014) compared to the non-dry eye individuals. Although the remaining participants showed a marginal increase in TMH and NITBUT levels, these changes did not achieve statistical significance (P>0.05). Similarly, the LLP levels were significantly improved with Systane® (P<0.001) post-treatment compared to individuals in the non-dry eye group. However, the dry eye subjects showed higher post-treatment LLP levels than the untreated group (P<0.02).

CONCLUSION

The short-term effects of Systane® eyelid wipes on tear film parameters suggest their effectiveness in dry eye disease. Nonetheless, further exploration of their long-term impact is essential to justify their cost effectiveness and efficacy in treating both aqueous deficiency and evaporative dryness.

Prevalence and Risk Factors of Dry Eye Disease in Association With the Increased Use of Electronic Devices Among University Students in Western Saudi Arabia

AIM

Dry eye disease (DED) is a prevalent ocular condition that significantly impacts individuals' quality of life and performance. It is charac-terized by the instability of the tear film, which causes ocular surface inflamma-tion and damage that leads to ocular symptoms. However, this study aimed to determine the prevalence of DED and identify associated risk factors among university students in western Saudi Arabia.

METHODS

A total of 402 university students participated in this study. The sample size was determined using Raosoft software (Raosoft, Inc., Seattle, WA), considering an estimated student population of 20,000. Data were collected between January and March 2023 through an online questionnaire distributed to the participants. The questionnaire comprised three sections, covering general information, behaviors related to digital device (DD) use, and the validated Arabic version of the Ocular Surface Disease Index (OSDI) questionnaire. OSDI scores were calculated, and the severity of DED was categorized using established cutoff points.

RESULTS

Among the 402 university students who took part in the survey, the majority (63.2%) were aged between 21 and 25 years, with females representing the dominant gender (72.9%). Notably, 90.8% of participants reported using DDs at bedtime. Over 60% of students had been using DDs for more than 10 years, and approximately 61.7% reported having more than six hours of daily screen time. Mobile devices were the most commonly used electronic devices (67.2%), and TikTok emerged as the most frequently used application (35.6%). Based on the OSDI criteria, 21.1% of students had mild DED symptoms, 14.9% had moderate symptoms, and 38.6% had severe symptoms. Hence, the prevalence of students exhibiting positive DED symptoms was 74.6%, while 25.4% were negative.

Symptomatic dry eye disease among university students

Background

Dry eye disease (DED) is a multifactorial condition often characterized by a reduction in tear film quantity or quality. This study aimed to determine the frequency of DED and its associated subjective symptoms among students of Mu'tah University.

Methods

In this cross-sectional study conducted at Mu'tah University, Mu'tah, Jordan, from January to April 2022, 489 students completed an online patient-reported DED symptom questionnaire and the ocular surface disease index (OSDI) questionnaire. Moreover, 106 participants underwent clinical examinations using the Schirmer test I and fluorescein tear breakup time (TBUT).

Results

Approximately 74.6% of the students self-reported experiencing DED symptoms, and 72.6% had an OSDI score > 12, which is considered the threshold for an abnormal ocular surface. Clinical examinations revealed low Schirmer test scores ( < 10 mm) in 26.4% (n = 28) and 25.5% (n = 27) of the right and left eyes, respectively. We observed low TBUT scores ( < 5 s) in 19.8% (n = 21) and 18.9% (n = 20) of the right and left eyes, respectively. We noted significant differences between the self-reported DED symptoms and the Schirmer test scores (P = 0.003 for both right and left eyes), TBUT (P < 0.001 for both right and left eyes), and OSDI score (P < 0.001 for each self-reported DED symptom). We observed a weak significant positive correlation between Schirmer test scores and TBUT in the right (r = + 0.30; P = 0.002) and left (r = + 0.34; P < 0.001) eyes; a negligible significant inverse correlation between OSDI scores and Schirmer test scores in the right (r = - 0.24; P = 0.013) and left (r = - 0.23; P = 0.019) eyes; and a negligible significant inverse correlation between the OSDI score and TBUT of the left eye (r = - 0.25; P = 0.011) but not of the right eye (r = - 0.17; P = 0.077).

Conclusions

The frequency of DED symptoms in this study was higher than that previously reported based on foreign statistics. The presence of self-reported DED symptoms was significantly associated with higher OSDI scores. Self-reported DED symptoms were more frequent than the abnormalities detected using objective methods. Therefore, a combination of subjective and objective measures may provide higher diagnostic yield for DED. Further studies are required to confirm this hypothesis.

Complementary and Alternative Medicine Use Among Patients with Dry Eye Syndrome in Saudi Arabia: A Survey Study

Introduction

Complementary and alternative medicine (CAM) includes all healthcare practices that are not part of conventional medicine. One of the most common eye disorders for visiting an ophthalmology clinic is dry eye disease (DED), and due to the increasing number of CAM used for eye conditions, 1 in 5 patients has been reported in previous studies to use CAM for eye treatment. This study aimed to estimate the prevalence of CAM use among patients with (DED).

Methods

A web-based survey was used to collect the data, the first part of the questionnaire was about demographic data, and the second part included a validated Arabic version of the ocular surface disease index (OSDI). The third part was about practices that alleviate DED other than conventional medicine.

Results

The total sample was 282, 61 were males, and 221 were females. Most participants (48.5%) were between 25 and 44 years old, 90% were Saudi, and only 10% were non-Saudi. Of the participant, 70% reported having attained a university or higher education level. The prevalence of the use of CAM among patients with dry eye was around 85%. The most frequently reported type of CAM used among the participants was faith healing (Ruqyah) (41%). This was followed by warm compressors (37%). There was no significant correlation between the severity of OSDI and using CAM, as the p-value was 0.909.

Conclusion

In conclusion, our study shows that CAM is a popular choice among patients with dry eye syndrome. Faith healing and warm compressors are the most used types of CAM. However, the lack of correlation between OSDI severity and CAM use indicates that patients may use CAM for reasons other than symptom severity. Further research is needed to explore the reasons behind CAM use and its effectiveness in managing dry eye syndrome.

Perfluorohexyloctane in dry eye disease: A systematic review of its efficacy and safety as a novel therapeutic agent

Perfluorohexyloctane (F6H8), a physically and chemically inert synthetic compound, has recently emerged as a promising candidate for the treatment of DED due to its unique properties. A systematic review that only include full-length randomized controlled studies (RCTs), reporting the effects of F6H8 in three databases, PubMed, Scopus and Web of Science, was performed according to the PRISMA statement. The search period was performed between June 1, 2023, and June 21, 2023. The Cochrane risk of bias tool was used to analyze the quality of the studies selected. A total of six RCTs were included in this systematic review. F6H8 tear substitutes treatment achieved a higher improvement than control group interventions in most of the reported variables. The mean differences between both groups were in favor of F6H8 and were as follow: eye dryness score (EDS) base on a visual analogue scale (VAS) of -6.12 ± 4.3 points, ocular surface disease index (OSDI) questionnaire score of -2.8 ± 2.3 points, lipid layer thickness (LLT) of 11.4 ± 10.4 μm, total corneal fluorescein staining (tCFS) of -0.8 ± 0.3 points and ocular treatment-emergent adverse events (TEAEs) of -0.66 ± 1.7. Tear film break-up time (TBUT) was the only variable in favor of control group with a mean of -0.5 ± 0.4 s. Patient satisfaction after F6H8 tear substitutes treatment was high. Therefore, F6H8 tear substitutes improve dry eye symptoms and signs with a satisfactory tolerability and could be recommended in patients with DED.

Prevalence and Determinants of Symptomatic Dry Eye Disease Among Adult Urban Residents of High-Altitude Areas of Southwest Saudi Arabia - A Survey

Purpose

To estimate the prevalence and determinants of Ocular Surface Disease Index (OSDI) score based dry eye disease (DED) among the adult urban population of four cities located at high altitudes in Southwest Saudi Arabia.

Methods

This cross-sectional survey was held in 2023. OSDI questionnaire was used to collect the responses of the adult participants. The score was further graded into none, mild, moderate, and severe DED to estimate age-sex-adjusted DED prevalence. The OSDI score was correlated to demographic (age group, gender, education, occupation, city) and risk factors like smoking and co-morbidities.

Results

Of the 401 adults, 388 (response rate of 97.8%) participated. The age-sex-adjusted prevalence of mild, moderate, and severe DED was 21.7%, 13.1%, and 32%, respectively. The median ODSI score was 22.9 [Interquartile range (IQR) 10.4; 47.9)]. The score was significantly higher in females (Mann-Whitney U-test P = 0.038), residents of Taif city (KW P = 0.05), those with primary/middle school education (Kruskal-Wallis P = 0.004), comorbidities like hypertension, asthma (KW P < 0.001) and risk factors like past refractive surgeries, arthritis (KW P = 0.013). Education status (P <0.001) [B = -9.0 95%] and presence of comorbidity (P = 0.022), [B = -0.823] were significant predictors of DED.

Conclusion

The prevalence of DED and severe grade was high. The level of education and presence of comorbidities significantly influenced DED in the adult urban Saudi population of cities at high altitudes.

Smartphone App-Based and Paper-Based Patient-Reported Outcomes Using a Disease-Specific Questionnaire for Dry Eye Disease: Randomized Crossover Equivalence Study

BACKGROUND

Using traditional patient-reported outcomes (PROs), such as paper-based questionnaires, is cumbersome in the era of web-based medical consultation and telemedicine. Electronic PROs may reduce the burden on patients if implemented widely. Considering promising reports of DryEyeRhythm, our in-house mHealth smartphone app for investigating dry eye disease (DED) and the electronic and paper-based Ocular Surface Disease Index (OSDI) should be evaluated and compared to determine their equivalency.

OBJECTIVE

The purpose of this study is to assess the equivalence between smartphone app-based and paper-based questionnaires for DED.

METHODS

This prospective, nonblinded, randomized crossover study enrolled 34 participants between April 2022 and June 2022 at a university hospital in Japan. The participants were allocated randomly into 2 groups in a 1:1 ratio. The paper-app group initially responded to the paper-based Japanese version of the OSDI (J-OSDI), followed by the app-based J-OSDI. The app-paper group responded to similar questionnaires but in reverse order. We performed an equivalence test based on minimal clinically important differences to assess the equivalence of the J-OSDI total scores between the 2 platforms (paper-based vs app-based). A 95% CI of the mean difference between the J-OSDI total scores within the ±7.0 range between the 2 platforms indicated equivalence. The internal consistency and agreement of the app-based J-OSDI were assessed with Cronbach α coefficients and intraclass correlation coefficient values.

RESULTS

A total of 33 participants were included in this study. The total scores for the app- and paper-based J-OSDI indicated satisfactory equivalence per our study definition (mean difference 1.8, 95% CI -1.4 to 5.0). Moreover, the app-based J-OSDI total score demonstrated good internal consistency and agreement (Cronbach α=.958; intraclass correlation=0.919; 95% CI 0.842 to 0.959) and was significantly correlated with its paper-based counterpart (Pearson correlation=0.932, P<.001).

CONCLUSIONS

This study demonstrated the equivalence of PROs between the app- and paper-based J-OSDI. Implementing the app-based J-OSDI in various scenarios, including telehealth, may have implications for the early diagnosis of DED and longitudinal monitoring of PROs.

Assessment of the efficacy of 0.1% cyclosporine A cationic emulsion in the treatment of dry eye disease during COVID-19 pandemic

Objective: To assess the efficacy of 0.1% cyclosporine A (CsA) cationic emulsion (CE) in the treatment of dry eye disease (DED) in terms of ocular surface disease index (OSDI). Methods: DED patients with corneal fluorescein staining grade (CFS) ≤ 3 on the Oxford scale and Schirmer test score < 10 mm/ 5 min were enrolled for once-daily CsA use in this observational, prospective, one-center study. Efficacy of CE at 30, 60, and 90-day follow-up visit was evaluated using OSDI questionnaire. Both the overall OSDI score and the outcomes for all subscales - ocular symptoms (OS), vision-related function (VRF) and environmental triggers (ET) were considered. Results: Twelve patients (10 women and 2 men), whose baseline OSDI ranged between 27.08 and 70.03 mm (48.2 ± 11.8), were included. Their achieved mean scores for subscales such OS, VRF and ET were 66.6 ± 16.8, 42.2 ± 12.0 and 42.2 ± 12.5, respectively. Statistically significant results were obtained after 30 days for OSDI (45.5 ± 10.0; p=0.011), whereas after 90 days for both OSDI (35.4 ± 7.4; p=0.003) and OS (47.2 ± 10.9; p=0.005), VRF (30.5 ± 6.1; p=0.003) and ET (33.3 ± 11.2; p=0.008). Conclusions: CsA CE significantly reduced symptoms of patients with DED. Recovery was the most successful after 90 days of treatment and included OSDI, OS, VRF and ET. Abbreviations: CE = cationic emulsion, CFS = corneal fluorescein staining, CsA = cyclosporine A, DED = dry eye disease, ET = environmental triggers, OS = ocular symptoms, OSDI = ocular surface disease index, VRF = vision-related function.

The validity and reliability of the Arabic version of the ocular surface disease index (OSDI) questionnaire in a sample of the Gazan population: a study from Palestine

PURPOSE

To develop an Arabic version of OSDI for the Gazan population.

METHODS

A cross-sectional observational study was conducted using a convenience sample technique. The translation procedure included five stages: forward translation, revision of translation, backward translation, refinement of translation, and a final test of the pre-final version. The final sets of questionnaires were constructed using an online JotForm platform. The online platform was chosen to automatically calculate the questionnaire's final overall score. Overall, 260 participants were instructed to fill out the English and the Arab-OSDI version twice to conduct the reliability of the translated version and repeatability evaluation.

RESULTS

The mean age of the participants was 33.45 ± 11.74 years old. Cronbach's alpha for all items was greater than 0.80, except for the "blurred vision" and "deteriorating vision" items (0.77 and 0.74, respectively). The mean overall score difference between the English-OSDI and Arab-OSDI was 0.86 based on the Bland-Altman chart. For repeatability, no significant difference in the overall scores between the two repeats of the Arab-OSDI (p = 0.632). The Arab-OSDI overall score (sessions 1 and 2) has a clinical difference (bias) of 0.21. Using the varimax rotation method, only three factors (ocular symptoms, vision-related function, and environmental triggers) had eigenvalues greater than one in the structure of the Arab-OSDI.

CONCLUSION

The Arab-OSDI is an appropriate, reliable, and repeatable tool for the determination of dry eye symptoms, ocular discomfort, and quality of life in the Gazan population. This version could remove the language barrier in answering OSDI items more easily.