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Assessment of the Dry Eye Questionnaire and a modified Ocular Surface Disease Index in children aged 6-17 years
Yi Pang1, Leo Y Ren2, Drake R Ren2
1Illinois College of Optometry, Chicago, Illinois, USA.
Insights
The DEQ-5 questionnaire shows potential for identifying dry eye symptoms in children, but its current five-level scale may not be optimal. Further research is needed to develop a child-specific dry eye assessment tool.
Area of Science:
- Ophthalmology
- Pediatric Health
- Clinical Assessment
Background:
- Dry eye disease is increasingly recognized in pediatric populations.
- Validated questionnaires are crucial for accurate diagnosis and management of pediatric dry eye.
- Existing adult dry eye questionnaires may require adaptation or revalidation for children.
Purpose of the Study:
- To validate the Dry Eye Questionnaire-5 (DEQ-5) and the Ocular Surface Disease Index (OSDI) in children aged 6-17 years using Rasch analysis.
- To determine the optimal cutoff value for the DEQ-5 to identify dry eye symptoms, as defined by the mOSDI.
- To assess the repeatability of both the DEQ-5 and mOSDI in a pediatric cohort.
Main Methods:
- 225 children aged 6-17 years participated.
- Participants completed the DEQ-5 and mOSDI questionnaires in a randomized order.
- Repeatability was assessed via retesting after 30 minutes in 72 participants.
- Receiver operating characteristic (ROC) curve analysis was used to determine DEQ-5 sensitivity and specificity.
- Rasch analysis was employed to evaluate questionnaire psychometric properties.
Main Results:
- A DEQ-5 cutoff score of ≥4.5 demonstrated a sensitivity of 72.2% and specificity of 66.1% for detecting dry eye symptoms.
- Rasch analysis indicated that the five-level response scales of both DEQ-5 and mOSDI had disordered item thresholds in children.
- Collapsing the response scales to three categories improved the overall model fit for both questionnaires.
- Females reported significantly higher OSDI scores compared to males.
Conclusions:
- While a DEQ-5 cutoff of ≥5 was identified for pediatric dry eye, it differs from the adult cutoff (≥6).
- The five-level response scales of the DEQ-5 and mOSDI may not be suitable for the pediatric population.
- There is a need to develop a novel dry eye questionnaire specifically designed for children to ensure accurate symptom assessment.
Purpose:
The purpose of this study was to validate DEQ-5 and mOSDI in children using Rasch analysis and determine the optimal cutoff value for DEQ-5 to differentiate dry eye symptoms defined by mOSDI in children aged 6-17 years. In addition, the repeatability of mOSDI and DEQ-5 were investigated in children.
Methods:
A total of 225 children were recruited. Both DEQ-5 and mOSDI were administered to participants in a randomized sequence. Retests of the two questionnaires were performed after 30 min in 72 participants. A receiver operating characteristic (ROC) curve was generated to determine the sensitivity and specificity of the DEQ-5 questionnaire for diagnosis of dry eye symptoms. Repeatability of both questionnaires was evaluated using coefficient of repeatability (CoR) and 95% limits of agreement.
Results:
The median of mOSDI score was 11.4 (Inter-quartile range: 4.5-20.5). The median DEQ-5 score was 4.0 (Inter-quartile range: 2.0-7.0). The area under the curve of the ROC curve for DEQ-5 was 0.78 (p < 0.0001). A DEQ-5 threshold of 4.5 yielded maximum sensitivity (72.2%) and specificity (66.1%) to differentiate dry eye symptoms in children. Females had significantly higher OSDI scores than males. CoR was ±4.8 for DEQ-5 and ±16.6 for mOSDI. The 95% limits of agreement were 5.5 to -4.2 for DEQ-5 and 16.5 to -16.7 for modified OSDI. Rasch analysis demonstrated that the five-level response scales in both the mOSDI and DEQ-5 produced disordered item thresholds. Collapsing the response scales from five to three categories improved overall model fit.
Conclusions:
Although we identified a DEQ-5 cutoff value of ≥5 for differentiating dry eye symptoms in children, which is different from that used in adults (≥6), the five-level response scales of both the mOSDI and DEQ-5 may not be optimal for the pediatric population and certain items might not be adequate to measure dry eye symptoms, thus we do not recommend using DEQ-5 in children to measure dry eye symptoms. This underscores the need to develop a dry eye questionnaire specifically designed for children to ensure more accurate assessment.
