Last week’s pearl looked at the various symptoms of dry eye, including those we expect (eye dryness) as well as the less straightforward ones such as tearing. Since dry eye symptoms are many and variable, let’s take a look at the best ways to assess them.
I think you have two choices to evaluate dry eye symptoms: a questionnaire, or very direct questions after obtaining a proper and thorough history. We’ll explore the options.
Questionnaires. A number of very effective validated questionnaires exist to identify dry eye symptoms. They include the SPEED, DEQ-5, and OSDI assessments. One advantage of using this approach is patients can complete these forms prior to the exam. This decreases time in the office—an important factor in the current COVID era—and it increases clinical efficiency. Secondly, these assessments provide a score that can be monitored to determine if a chosen treatment is effective. One last benefit of validated questionnaires is they often have a cutoff. For example, a score over 6 on the SPEED questionnaire indicates dry eye. However, one disadvantage of using questionnaires is some include terminology that is confusing to patients, which may result in a patient’s inability to complete the forms without clarification.
Direct Questions. Along with obtaining a prior history review and possibly issuing a questionnaire assessment, I tend to focus on two questions when I see my DED patients for the exam: What is your worst symptom, and what time of day is it the worst? For example, patients with photophobia tend to have more significant SPK and advanced KCS, while patients with morning symptoms often have incomplete lid closure. It’s easier to select a dry eye treatment once the primary symptom and its peak time of day are identified.
KEY TAKEAWAY: Consider questionnaires to provide a baseline symptoms score and increase clinical efficiency; ask patients direct questions during the exam to quickly identify dry eye symptoms and a possible therapeutic strategy.
Supported by an independent medical grant from Kala Pharmaceuticals
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