Abstract: OSDI and the post-menopausal dry eye...

Aha. An opportunity to preach a sermon on a favorite topic.

As many of you know I've long been a fan of the OSDI. It's a quick 12-question survey (technically, a scientifically validated instrument) that I encourage all patients to use regularly to 'quantify' their dry eye symptoms. Complete it and take it to doctor appointments, especially if you're seeing a new doctor for the first time. Also, score yourself before and a month and three months after commencing any new treatments. If you want meaningful data, school yourself not to change your routine or treatments during that time.

Patients, if you've ever had the uncomfortable experience of trying to communicate how much pain you're in to a doctor who is looking quizzically (or worse) at you after gazing at your apparently 'quiet' corneas under a slit-lamp, the OSDI is for you. Your doctor cannot brush it aside as irrelevant. If they do, they're basically also saying that Restasis should never have been approved.

Doctors, if you've ever been tempted to think your dry eye patients who don't have glaring clinical signs are whining malcontents, I dare you to make all your patients (not just the dry eye ones) complete this survey with no explanation and then tabulate the data.

Here's a link to download a PDF copy.

Some years ago when Restasis first came on the market, Allergan reps distributed tear-off pads with this survey so doctors could use it to measure how patients are doing before and after starting on the drug. Wish they hadn't left off, but maybe we can collectively re-popularize it.

Clinical signs and symptoms in post-menopausal females with symptoms of dry eye.
Srinivasan S, Joyce E, Senchyna M, Simpson T, Jones L.
Ophthalmic Physiol Opt. 2008 Jul;28(4):365-72

Purpose: To characterize clinical signs and symptoms in a group of post-menopausal (PM) females who present with and without symptoms of dry eye.
Methods: Eighty-three healthy PM females were categorized as being symptomatic or asymptomatic of dry eye based on their response to the Allergan Ocular Surface Disease Index((c)) (OSDI) questionnaire. Non-invasive tear breakup time (NITBUT) was evaluated using the ALCON Eyemap(R). Tear volume was assessed using the phenol red thread (PRT) test and bulbar conjunctival hyperaemia was measured using objective and subjective methods.
Results: The total OSDI score (TOS) and subscores for the non-dry eye (NDE; n = 39) and dry eye (DE; n = 44) groups were significantly different (TOS: NDE = 7.43 +/- 7.71 vs DE = 24.87 +/- 13.89; p < 0.001). The DE group exhibited a shorter NITBUT (5.3 +/- 1.7 s vs 7.0 +/- 2.7 s; p = 0.0012). Tear volume was lower for the DE group (19.3 +/- 5.1 mm vs 16.3 +/- 5.6 mm; p = 0.031). Bulbar hyperaemia was higher in the DE group for both subjective grading using a modified CCLRU scale (48.4 +/- 10.0 vs 40.6 +/- 10.4; p = 0.0011) and objective measurement by spectrophotometer (Commission Internationale de l'Eclairage u' value = 0.285 +/- 0.006 vs 0.282 +/- 0.006; p = 0.005).
Conclusions: OSDI can be used to separate PM females who demonstrate clinical signs of ocular dryness. PM women with dry eye symptoms demonstrate shorter NITBUT, lower tear volume and increased bulbar conjunctival hyperaemia than those who have no symptoms.