title: The diagnosis and characteristics of moderate dry eye in non-contact lens wearers.
abstract: OBJECTIVE
  To identify and characterize moderate dry eye in non-contact lens wearers with a new scoring system-based dry eye questionnaire and to determine which objective tests better differentiate patients with moderate dry eye from healthy patients.
  
  
  METHODS
  Fifty-two healthy subjects (21 women and 31 men with a mean age of 27.8 +/- 9.2 years) and 37 subjects with moderate dry eye (33 women and 4 men with a mean age of 36.4 +/- 12.9 years) completed a 42-item dry eye questionnaire. Seventeen healthy subjects (11 women and 6 men with a mean age of 30.5 +/- 9.7 years) and 28 subjects with moderate dry eye (24 women and 4 men with a mean age of 38.50 +/- 3.8 years) underwent additional objective assessment of ocular surface health, tear osmolality, tear stability, and tear volume.
  
  
  RESULTS
  Subjects with moderate dry eye scored significantly higher (49.8 +/- 20.3, P<0.0001) on the dry eye questionnaire than did normal subjects (11.7 +/- 10.3). Ocular irritation symptoms worsened with progression of time of day in both groups of subjects. Internal reliability (0.95 Cronbach alpha) was excellent, and concurrent validity (Spearman rho 0.507) was acceptable when compared to the McMonnies and Ho dry eye questionnaire. Significant differences in tear osmolality (P<0.00001), invasive tear breakup time (P<0.034), and corneal vital dye staining (P<0.0001) were detected between the two groups of subjects. A stepwise linear regression on objective clinical tests, however, did not account for 77% of the total variance in the questionnaire scores.
  
  
  CONCLUSIONS
  A unique scoring system-based dry eye questionnaire was validated to separate non-contact lens wearers with moderate dry eye from healthy subjects. Objective tests of tear osmolality and stability and ocular surface integrity were better than other clinical measures at identifying differences between the two subject groups. The results strongly support the evidence that the diagnosis and treatment of moderate dry eye requires a detailed assessment of self-perceived symptoms and that objective clinical testing alone may be insufficient.
authors.affiliation: Texas Eye Research and Technology Center, College of Optometry, University of Houston, Houston, TX 77204-2020, USA. jbergmanson@uh.edu
authors.forename: Srihari
authors.initials: S
authors.lastname: Narayanan
authors.forename: William L
authors.initials: WL
authors.lastname: Miller
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Prager
authors.forename: Julie A
authors.initials: JA
authors.lastname: Jackson
authors.forename: Norman E
authors.initials: NE
authors.lastname: Leach
authors.forename: Alison M
authors.initials: AM
authors.lastname: McDermott
authors.forename: Mike T
authors.initials: MT
authors.lastname: Christensen
authors.forename: Jan P G
authors.initials: JP
authors.lastname: Bergmanson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003261:Contact Lenses; D003941:Diagnostic Techniques, Ophthalmological; D015352:Dry Eye Syndromes / Q000145:classification / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013666:Tears / Q000378:metabolism