Assessment of variation in bulbar conjunctival redness, temperature, and blood flow.

PURPOSE: To assess the diurnal variation in bulbar conjunctival redness, conjunctival temperature, and conjunctival blood flow. METHODS: Bulbar redness was quantified by CIE u' chromaticity using a SpectraScan PR650 spectrophotometer. Conjunctival temperature was measured using a Tasco-Thi 500 infrared thermometer. Measurements of conjunctival blood flow were obtained using a modified Heidelberg Retinal Flowmeter (HRF). Measurements on 10 subjects were made on a periodic basis over the day and on waking. RESULTS: For each factor measured a cyclical pattern was observed, with highest values on waking, a reduction in values towards mid-day, and then a gradual increase over the remainder of the day. There was a significant effect of time for redness, temperature, and conjunctival blood flow (p < 0.001 for all three variables), with no significant difference in the cyclical pattern between eyes being observed (p = NS). CONCLUSIONS: Diurnal bulbar redness, temperature, and conjunctival blood flow variation may be objectively quantified and all three are lowest during the middle of the day and maximal at the start of the day. This information should be considered when undertaking studies in which redness, temperature, and ocular surface blood flow are important outcome variables and time of day is a potential confounding factor.

The agreement between self-assessment and clinician assessment of dry eye severity.

PURPOSE: The purpose of this analysis was to measure the degree of agreement between clinicians' assessment and subjects' self-assessment of dry eye severity in a cross-sectional, observational dry eye study. A secondary purpose was to identify the role of gender and age in that concordance. METHODS: In a cross-sectional observational study, 162 dry eye subjects and 48 controls were recruited from clinical databases of ICD-9 codes in 6 clinical sites. Before examination, subjects gave a global self-assessment of the severity of their dry eye from "none" to "extremely severe." After a clinical examination that included dry eye tests, the clinician discussed the subjects' symptoms and then gave global clinician assessment of dry eye from "none" to "severe." We measured the degree of agreement in these global measures. RESULTS: Although the correlation and agreement between clinician and self-assessment was significant (r = 0.720, P = 0.000; weighted K = 0.471; 95% CI = 0.395, 0.548; P = 0.000), the clinician assessment underestimated the severity in 40.9% of the subjects by at least 1 grade compared with the subjects' self-assessment. Over 54% of subjects over age 65 and 43% of the female subjects had their condition underestimated by the clinician (P < 0.05). CONCLUSIONS: Clinicians often relatively underestimated the severity of the subjects' self-assessment of dry eye in this clinical study, especially among the elderly and women. Eye care practitioners need better, more quantitative tools for the assessment of ocular surface symptoms to improve the concordance in severity assessment and to meet the needs of this symptomatic patient population by offering them appropriate treatments.

The relative burden of dry eye in patients' lives: comparisons to a U.S. normative sample.

PURPOSE: To assess the relative burden of dry eye in daily life by comparing Short Form-36 (SF-36) responses from individuals with and without dry eye against U.S. norms. METHODS: Assessment of 210 people, 130 with non-Sjogren's keratoconjunctivitis sicca (non-SS KCS), 32 with Sjogren's Syndrome (SS), and 48 control subjects. The study population data and published normative SF-36 data were compared. Dry eye severity was assessed by recruited severity (control, non-SS KCS, SS), patient self-report (none, very mild/mild, moderate, severe/extremely severe), and clinician-report (none, mild, moderate, severe). Age- and gender-matched norms were compared with all defined severity groups. RESULTS: Compared with the norms, control subjects scored higher on all SF-36 scales. Effect size (ES) ranged from 0.15 to 0.52. Non-SS KCS patients had lower Role-Physical (ES=-0.07), Bodily Pain (ES=-0.08), and Vitality (ES=-0.11) scores, indicating more dry eye impact on those areas versus the norm. All SF-36 scale scores except Mental Health (ES=0.12) were lower in the SS group than the adjusted norm (ES range: -0.16 to -0.99). Regardless of severity classification, mild patients consistently had lower Role-Physical and Bodily Pain scores than the norm, suggesting impact on daily roles (ES < 0.2). Patients with moderately severe disease also experienced less vitality and poorer general health. The group with severe disease scored lower than the norm across all domains (ES range: -0.14 to -0.91) except Role-Emotional (ES=0.13) and Mental Health (ES=0.23). CONCLUSIONS: These results indicate dry eye's negative impact on everyday life, particularly in daily activities. Further research using disease-specific measures to examine dry eye's impact is underway.