Real-world practice patterns for dry eye diagnosis: a multicenter observational study in Taiwan

To investigate the concordance between Asia Dry Eye Society (ADES) diagnostic criteria and real-world hospital-based practice, and to analyze the clinical characteristics of patients with dry eye disease (DED), in Taiwan.

Noninterventional, cross-sectional, retrospective clinical study.

Data were analyzed for adults with newly diagnosed DED from three tertiary hospitals. The primary endpoint was the proportion of patients diagnosed with DED who fulfilled ADES criteria for DED. Other outcomes were DED classification and severity, tear breakup time (TBUT), Schirmer's test, corneal fluorescein staining (CFS) severity, 12-item Ocular Surface Disease Index (OSDI) questionnaire scores, and presence of meibomian gland dysfunction (MGD).

A total of 213 patients, mean (SD) age 54.3 (15.0) years, 79.8% female, were evaluated. Mean TBUT of 3.0 (2.6) sec and mean OSDI score of 36.5 (21.0) indicated severe DED at diagnosis. Most patients (87.3%) had a TBUT ≤5 sec, fulfilling ADES diagnostic criteria. Short TBUT (≤5 sec) and OSDI ≥13 had high sensitivity for diagnosing DED (87.3% and 90.1%, respectively), whereas an abnormal Schirmer's test (69.5%) and abnormal CFS (42.3%) were less sensitive. MGD was diagnosed in 56.3% of patients. Dry eye-related characteristics in the non-short TBUT (>5 sec) group diverged for objective but not subjective clinical tests. Most common first treatments were artificial tears (95.8%) and corticosteroids (85.0%).

DED diagnosis in routine hospital practice in Taiwan is highly concordant (87.3%) with ADES diagnostic criteria. TBUT appears to be an effective diagnostic tool for identifying dry eye in patients across symptom severity, etiology and age.