Multiple Dry Eye Disease Assessments May Limit Misdiagnosis

Performing multiple dry eye disease assessments may be the best strategy for accurately diagnosing the disorder in individuals who are symptomatic, according to research published in Contact Lens and Anterior Eye. 

A researcher calculated the probability of a true positive for individuals with a positive dry eye disease diagnosis obtained using different tests. Global specificity and sensitivity values were estimated for each test, and probabilities for a correct diagnosis were calculated based on an assumed dry eye disease prevalence of 11.6%. 

Corneal staining demonstrated the greatest accuracy for diagnosing dry eye disease (probability, 0.28), followed by osmolarity and conjunctival staining (probability, 0.24 for both). When simultaneously assessing corneal and conjunctival staining, the probability of a correct diagnosis increased to 0.49. Ocular Surface Disease Index (OSDI) was the least accurate assessment for diagnosing dry eye disease (probability, 0.14), followed by non invasive breakup time (NBUT; probability, 0.19), 5-item Dry Eye Questionnaire (DEQ-5; probability, 0.20) and fluorescein breakup time (probability, 0.20). 

Using multiple dry eye disease assessments improved the probability of accurately diagnosing dry eye disease, and combined positive results from the of DEQ-5, conjunctival and corneal staining, osmolarity, and tear breakup time (TBUT) assessments yielded a 0.90 probability of accurately diagnosing dry eye disease. When combining 2 tests with the presence of patient symptoms, the DEQ-5 plus corneal staining showed the best diagnostic ability for detecting dry eye disease (0.42), while the probability of a correct diagnosis was worst with combined OSDI and TBUT testing (0.23).  

“Reliance on any single procedure, including symptoms, carries a substantial risk of misdiagnosis, as does the combination of symptoms with any single sign,” according to the study author. “The most useful single procedure is corneal staining, but the likelihood of correct diagnosis is considerably improved by considering the simultaneous occurrence of conjunctival AND corneal staining as the key positive outcome. It is recommended that this criterion be specified in diagnostic guidelines for dry eye disease.”

Study limitations include differences in dry eye disease prevalence values between studies.