School of Optometry & Vision Science, L3 Rupert Myers Building, UNSW, Kensington, NSW 2052, Australia.
Cont Lens Anterior Eye. 2023 Oct;46(5):102048. doi: 10.1016/j.clae.2023.102048. Epub 2023 Aug 4.
To demonstrate how the likelihood of making a correct diagnosis of dry eye disease varies according to the clinical test methods used.
The probability of a person having dry eye, given that they return a positive test, was calculated for a range of standard tests, using the Bayes-Price rule. Global specificity and sensitivity values for each test were estimated by employing the Beta distribution to combine all relevant data obtained from a literature review.
At an assumed prevalence of 11.6%, the single test with the highest probability of a correct diagnosis was corneal staining (probability = 0.28) and the lowest was the ocular surface disease index - OSDI (0.14). The best combination of symptoms with a single test of tear film homeostasis was the 5-item dry eye questionnaire (DEQ-5) + corneal staining (0.42) while OSDI + tear film break up time (TBUT) was the worst (0.23). The simultaneous observation of conjunctival and corneal staining was associated with a probability of 0.49. The probability of a correct diagnosis increased with the number of positive tests, up to a maximum of 0.90 when all of DEQ-5, conjunctival and corneal staining, osmolarity and TBUT were positive.
A significant risk of misdiagnosis is associated with using any single test for dry eye disease, or the minimum TFOS DEWS II criterion of symptoms plus any single test of tear film homeostasis. To minimize this risk, the maximum number of tests available should be performed and the results used to inform diagnosis. The simultaneous occurrence of conjunctival and corneal staining should be considered a key outcome and be specified in future guidelines.
展示根据所使用的临床测试方法，诊断干眼症的准确性会如何变化。
使用贝叶斯-普赖斯规则，计算了一系列标准测试中，某人在测试结果呈阳性的情况下患有干眼症的概率。通过使用 Beta 分布来合并从文献综述中获得的所有相关数据，估计了每种测试的总体特异性和敏感性值。
在假设的患病率为 11.6%的情况下，单项测试中诊断正确的可能性最高的是角膜染色（概率=0.28），而最低的是眼表面疾病指数 - OSDI（0.14）。症状与单一泪膜稳态测试的最佳组合是 5 项干眼问卷（DEQ-5）+角膜染色（0.42），而 OSDI+泪膜破裂时间（TBUT）则是最差的组合（0.23）。同时观察结膜和角膜染色与概率为 0.49 相关。随着阳性测试数量的增加，正确诊断的概率也会增加，当 DEQ-5、结膜和角膜染色、渗透压和 TBUT 全部为阳性时，正确诊断的概率最高可达 0.90。
使用任何单一的干眼症测试，或者最低的 TFOS DEWS II 标准（症状加上任何单一的泪膜稳态测试）进行诊断，都存在很大的误诊风险。为了最大程度地降低这种风险，应尽可能进行最多数量的测试，并将结果用于诊断。同时出现结膜和角膜染色应被视为一个关键的结果，并在未来的指南中进行规定。
