title: The agreement between self-assessment and clinician assessment of dry eye severity.
abstract: OBJECTIVE
  The purpose of this analysis was to measure the degree of agreement between clinicians' assessment and subjects' self-assessment of dry eye severity in a cross-sectional, observational dry eye study. A secondary purpose was to identify the role of gender and age in that concordance.
  
  
  METHODS
  In a cross-sectional observational study, 162 dry eye subjects and 48 controls were recruited from clinical databases of ICD-9 codes in 6 clinical sites. Before examination, subjects gave a global self-assessment of the severity of their dry eye from "none" to "extremely severe." After a clinical examination that included dry eye tests, the clinician discussed the subjects' symptoms and then gave global clinician assessment of dry eye from "none" to "severe." We measured the degree of agreement in these global measures.
  
  
  RESULTS
  Although the correlation and agreement between clinician and self-assessment was significant (r = 0.720, P = 0.000; weighted K = 0.471; 95% CI = 0.395, 0.548; P = 0.000), the clinician assessment underestimated the severity in 40.9% of the subjects by at least 1 grade compared with the subjects' self-assessment. Over 54% of subjects over age 65 and 43% of the female subjects had their condition underestimated by the clinician (P < 0.05).
  
  
  CONCLUSIONS
  Clinicians often relatively underestimated the severity of the subjects' self-assessment of dry eye in this clinical study, especially among the elderly and women. Eye care practitioners need better, more quantitative tools for the assessment of ocular surface symptoms to improve the concordance in severity assessment and to meet the needs of this symptomatic patient population by offering them appropriate treatments.
authors.affiliation: Clinical Trial Consultant, Atlanta, Georgia, USA. robinchalmers@mindspring.com
authors.forename: Robin L
authors.initials: RL
authors.lastname: Chalmers
authors.forename: Carolyn G
authors.initials: CG
authors.lastname: Begley
authors.forename: Tim
authors.initials: T
authors.lastname: Edrington
authors.forename: Barbara
authors.initials: B
authors.lastname: Caffery
authors.forename: Dan
authors.initials: D
authors.lastname: Nelson
authors.forename: Christopher
authors.initials: C
authors.lastname: Snyder
authors.forename: Trefford
authors.initials: T
authors.lastname: Simpson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003941:Diagnostic Techniques, Ophthalmological; D015352:Dry Eye Syndromes / Q000145:classification / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology; D015203:Reproducibility of Results; D016353:Self-Examination; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires