Translation and preliminary validation of a Chinese version of a short dry eye symptom questionnaire

To translate a short dry eye symptom questionnaire into Chinese and evaluate its psychometric properties and screening performance for Ocular Surface Disease Index-defined symptomatic dry eye.

The questionnaire was translated by forward-backward translation. In an anonymous online survey, 525 adults completed the Chinese short questionnaire and the Ocular Surface Disease Index. The original instrument includes two symptom-frequency items and one prior clinical diagnosis item; psychometric analyses used the summed dryness and irritation score. Ocular Surface Disease Index total scores were recalculated using the original algorithm, excluding "not applicable" responses from the denominator. Internal consistency was assessed with Cronbach's alpha, and convergent validity with Spearman correlations against Ocular Surface Disease Index total and domain scores. Receiver operating characteristic analysis used Ocular Surface Disease Index-defined symptomatic dry eye, defined as a score of 13 or greater, as the reference standard. The cutoff was selected by maximizing the Youden index.

All 525 questionnaires were retained. The median age was 32 years (interquartile range, 23-42), and 286/491 participants with valid sex coding (58.2%) were female. The median Ocular Surface Disease Index total score was 15.0 (interquartile range, 6.82-25.00), and 299/525 participants (57.0%) had Ocular Surface Disease Index-defined symptomatic dry eye. Internal consistency for the two symptom-frequency items was acceptable (Cronbach's alpha = 0.758). The two-item symptom sum correlated moderately with the Ocular Surface Disease Index total score (Spearman's rho = 0.669, P < 0.001), symptom domain (rho = 0.612), function domain (rho = 0.509), and environmental trigger domain (rho = 0.567; all P values < 0.001). The area under the receiver operating characteristic curve was 0.791. The practical cutoff was a two-item symptom sum of 4 or greater, with sensitivity of 89.3%, specificity of 56.2%, and overall agreement of 75.0% (Cohen's kappa = 0.472).

The Chinese short questionnaire showed acceptable internal consistency, convergent validity, and moderate screening performance for Ocular Surface Disease Index-defined symptomatic dry eye. Its brevity supports symptom screening, but it should not be interpreted as a standalone diagnostic instrument for clinically confirmed dry eye disease.