title: Symptom burden of patients with dry eye disease: a four domain analysis.
abstract: OBJECTIVE
  To determine which sensory (symptom persistence and intensity) and reactive (activity and affective interference) domains of symptom analysis are essential for assessing symptom burden in dry eye disease (DED) patients.
  
  
  METHODS
  A symptom domain tool was developed to investigate all four symptom domains in DED. In a cross-sectional pilot study, we administered the symptom burden tool and the Ocular Surface Disease Index (OSDI) questionnaire to 48 DED patients. Total and domain scores from the symptom burden tool and the OSDI were normalized to achieve comparability. Spearman correlation coefficients were calculated to measure the relationship between domains and subscales. Agreement between the symptom burden tool and OSDI was assessed by Bland-Altman plot. Assigned treatments were compared by symptom burden to determine whether treatment aggressiveness is linked to symptom intensity.
  
  
  RESULTS
  There was high agreement between the symptom burden tool and the OSDI. Symptom persistence had a stronger correlation with affective interference (r  =  0.62 for the symptom burden tool and r = 0.73 for the OSDI) than activity interference (r = 0.58 for the symptom burden tool and r = 0.60 for the OSDI). Symptom intensity correlated weakly with affective interference (r = 0.38) and activity interference (r = 0.37) in the symptom burden tool (OSDI does not have a subscale for intensity). In patients with equal persistence of symptoms, those having high symptom intensity were receiving more aggressive treatment (66.7%) than those with lower symptom intensity (33.3%).
  
  
  CONCLUSIONS
  Persistence of symptoms correlates better with affective interference than activity interference. Intensity of symptoms may be important for treatment decisions.
authors.affiliation: Corneal Neurobiology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, United States of America ; Department of Epidemiology and Biostatistics, University of Illinois at Chicago, School of Public Health, Chicago, Illinois, United States of America.
authors.forename: Joelle A
authors.initials: JA
authors.lastname: Hallak
authors.affiliation: Corneal Neurobiology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, United States of America.
authors.forename: Sarmad
authors.initials: S
authors.lastname: Jassim
authors.affiliation: Corneal Neurobiology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, United States of America.
authors.forename: Vishakha
authors.initials: V
authors.lastname: Khanolkar
authors.affiliation: Corneal Neurobiology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, United States of America.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Jain
mesh_terms: D000328:Adult; D000368:Aged; D003941:Diagnostic Techniques, Ophthalmological; D015352:Dry Eye Syndromes / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires