Associations between signs and symptoms of dry eye disease: a systematic review

Abstract

PurposeThe accurate diagnosis and classification of dry eye disease (DED) is challenging owing to wide variations in symptoms and lack of a single reliable clinical assessment. In addition, changes and severity of clinical signs often do not correspond to patient-reported symptoms. To better understand the inconsistencies observed between signs and symptoms, we conducted a systematic literature review to evaluate published studies reporting associations between patient-reported symptoms and clinical signs of DED.MethodsPubMed and Embase were searched for English-language articles on the association between clinical signs and symptoms of DED up to February 2014 (no lower limit was set).ResultsThirty-four articles were identified that assessed associations between signs and symptoms, among which 33 unique studies were reported. These included 175 individual sign–symptom association analyses. Statistical significance was reported for associations between sign and symptom measures in 21 of 33 (64%) studies, but for only 42 of 175 (24%) individual analyses. Of 175 individual analyses, 148 reported correlation coefficients, of which the majority (129/148; 87%) were between −0.4 and 0.4, indicating low-to-moderate correlation. Of all individual analyses that demonstrated a statistically significant association, one-half (56%) of reported correlation coefficients were in this range. No clear trends were observed in relation to the strength of associations relative to study size, statistical methods, or study region, although results from three studies did suggest that disease severity may be a factor.ConclusionAssociations between DED signs and symptoms are low and inconsistent, which may have implications for monitoring the response to treatment, both in the clinic and in clinical trials. Further studies to increase understanding of the etiopathogenesis of DED and to identify the most reliable and relevant measures of disease are needed to enhance clinical assessment of DED and the measurement of response to therapeutic interventions.

Lifitegrast clinical efficacy for treatment of signs and symptoms of dry eye disease across three randomized controlled trials

“…As in previous DED research 12 , outcomes for signs and symptoms of DED are poorly correlated in the lifitegrast clinical trials. In post hoc analyses from OPUS-1 and OPUS-2, the treatment effect on symptoms was greater among participants with higher baseline symptomatology scores.…”

“…Complexities in grading corneal staining for participants with advanced corneal defects may also contribute to the discordance between DED signs and symptoms. Indeed, given the paradoxical relationship between signs and symptoms of DED that have been observed in the lifitegrast clinical trials and the broader literature 12 , it may not be possible to achieve statistical success with coprimary (sign and symptom) endpoints in a single study. Key DED characteristics necessary to detect an outcome for symptoms may be distinct from those needed to detect an outcome for signs.…”

Serum levels of vitamin A, visual function and ocular surface after bariatric surgery

“…A systematic review has shown that the association between clinical signs of dry eye and symptoms described by patients is low and inconsistent (4) . Similar results have been highlighted in a study carried out with 635 patients with dry eye: the concordance rate was too low among Schirmer's test I, rose bengal staining, accumulation of fluorescein and TRFL test (18) .…”

Ocular Problems in High-Altitude Traveling: A Review With Focus on Management

“…12 Dry eye disease is exacerbated in the dry, windy, and sun glare conditions seen at high altitudes. 13 Severe dry eye disease can be associated with some autoimmune disorders, and commonly-used medications can exacerbate ocular dryness.…”