Sullivan Benjamin D, Smith Guy T, Gupta Arun, Harman Francesca, Ansari Ejaz
Trukera Medical, Southlake, TX, USA.
The Great Western Hospital NHS Trust, Swindon, UK.
Clin Ophthalmol. 2024 Mar 8;18:743-753. doi: 10.2147/OPTH.S452149. eCollection 2024.
To understand the impact of subjectivity on diagnosis rates of dry eye disease (DED) in an unbiased population.
A multicenter study enrolled 818 subjects with complete report forms (465 females, 67.1 ± 16.7 years, 353 males, 65.0 ± 15.9 years). Subjects were evaluated for staining, TBUT, tear osmolarity, meibomian gland disease, and OSDI.
Physicians diagnosed 48.7% of subjects as having DED, ranging from 42.9% to 62.3% between sites. Positivity rates for staining (≥ grade 1) ranged from 41.3% to 84.1% (mean = 0.8 ± 0.9 grade), TBUT (<10s) ranged from 39.1% to 61.6% (mean = 10.4 ± 6.6 seconds), osmolarity (>308 mOsm/L) ranged from 63.7% to 72.4% (mean = 319.7 ± 20.8), MGD grading ranged from 28.9% to 51.3% (mean = 0.5 ± 0.7), and symptoms measured by OSDI ranged from 57.6% to 71.0% (mean = 23.5 ± 20.5) between sites. Tear osmolarity was the most consistent between sites (max/min positivity = 114%), followed by OSDI (123%), TBUT (158%), MGD (178%), and staining (204%). DED markers were uncorrelated (average = 0.05 ± 0.07). A substantial number of subjects (N = 110) exhibited positive symptoms (OSDI = 32.4 ± 15.7) and hyperosmolarity (338.1 ± 20.1 mOsm/L) but no other obvious signs of DED (MGD grade = 0.2 ± 0.4, TBUT = 13.5 ± 7.0 seconds, staining grade = 0.4 ± 0.5).
Subjective signs of DED varied considerably, whereas objective measurements of OSDI and osmolarity were the most consistent between sites. A large proportion of subjects exhibited high symptoms and hyperosmolarity but no other obvious signs of dry eye disease, most of whom were undiagnosed by clinical assessment without access to the osmolarity measurement.
了解主观性对无偏倚人群中干眼症（DED）诊断率的影响。
一项多中心研究纳入了818名填写了完整报告表的受试者（465名女性，年龄67.1±16.7岁；353名男性，年龄65.0±15.9岁）。对受试者进行了染色、泪膜破裂时间（TBUT）、泪液渗透压、睑板腺疾病及眼表疾病指数（OSDI）评估。
医生诊断48.7%的受试者患有DED，各研究点的诊断率在42.9%至62.3%之间。染色阳性率（≥1级）在41.3%至84.1%之间（平均等级为0.8±0.9级），TBUT（<10秒）在39.1%至61.6%之间（平均为10.4±6.6秒），渗透压（>308 mOsm/L）在63.7%至72.4%之间（平均为319.7±20.8），睑板腺疾病分级在28.9%至51.3%之间（平均为0.5±0.7），各研究点间通过OSDI测量的症状发生率在57.6%至71.0%之间（平均为23.5±20.5）。泪液渗透压在各研究点间最为一致（最大/最小阳性率=114%），其次是OSDI（123%）、TBUT（158%）、睑板腺疾病（178%）和染色（204%）。DED各项指标之间无相关性（平均为0.05±0.07）。相当数量的受试者（N=110）表现出阳性症状（OSDI=32.4±15.7）和高渗状态（338.1±20.1 mOsm/L），但无其他明显的DED体征（睑板腺疾病分级=0.2±0.4，TBUT=13.5±7.0秒，染色分级=0.4±0.5）。
DED的主观体征差异很大，而OSDI和渗透压的客观测量在各研究点间最为一致。很大一部分受试者表现出高症状和高渗状态，但无其他明显的干眼症体征，其中大多数人未经临床评估且未进行渗透压测量而未被诊断。
