Have you ever had drops prescribed or other treatment for dry eye? Soreness 2. Scratchiness 3. Dryness 4. Grittiness 5. The version of the McMonnies questionnaire was used in the present study.
|Published (Last):||5 January 2015|
|PDF File Size:||17.53 Mb|
|ePub File Size:||14.40 Mb|
|Price:||Free* [*Free Regsitration Required]|
Proposed cut-off points of each group are those with the highest specificity after setting the sensitivity at a value above 0.
Discussion To our knowledge, this is the first multicenter study with a large sample investigating the diagnostic efficacy of the McMonnies questionnaire. Our results suggest that the instrument shows poor internal consistency, excellent validity, and moderate discriminating ability as a screening survey for dry eye in Chinese outpatients.
The McMonnies questionnaire was initially developed by reviewing literature, and scores of each item were tabulated based on clinical experience [ 10 ]. Several reports evaluating the diagnostic efficacy of the questionnaire have been published since then. The results were deemed biased, because they were derived from the same sample from which the cut-off value was determined.
Still, the data were affected by spectrum bias, since the severity of the disease in the study population was highly selective. Later on, Nichols et al. Moreover, differences in the diagnostic criteria of dry eye used in these studies made it challenging to compare the results.
Nonetheless, certain psychometric properties of the McMonnies questionnaire can be compared with other studies, because they are irrelevant to diagnostic criteria. Such low internal reliability implies that each item of the instrument measures rather independent aspects of dry eye. This is also why the items failed to cluster into any logical domains by factor analysis.
These were consistent with the results of Nichols et al. The authors inferred that the poor internal consistency would undermine the power associated with statistical significance tests, when comparing the scores between different groups or over time.
Similar conclusions have been made using Rasch analysis [ 15 ], suggesting that the McMonnies questionnaire does not function as a measure. Unlike previous studies, the instrument was found to have fine validity in our study population. The scores not only differed significantly between the dry eye and control groups but also strongly correlated with the results of TBUT and Schirmer I test. Several prevalence studies [ 16 , 17 ] have indicated poor correlations between dry eye symptoms and objective clinical tests.
Even so, we would argue that the McMonnies questionnaire is comprised of many aspects of dry eye rather than symptoms. It is possible that the objective test results are correlated with some unknown factors such as age, gender, or secondary symptoms caused by environmental triggers. Besides, Hong et al.
Differences in the ethnicity of the study populations may also contribute, which is beyond the scope of our study. The McMonnies questionnaire showed moderate accuracy in screening dry eye. Further analysis of the ROC curves revealed varying discriminating abilities among different gender and age subgroups, as the AUCs decreased with age.
This is a bit surprising, since the instrument was originally developed and adjusted with subjects over 45 years old [ 11 ]. Again, variations in experimental samples and criteria used for disease diagnosis should be taken into account here.
The differences in diagnostic efficacy among each subgroup are substantial, especially when applied with the same threshold of Therefore, we believe it is necessary to assign separate cut-off values for different gender and age subpopulation. As a screening method for dry eye, the McMonnies questionnaire is extremely cost-effective as it could be conducted in a self-administered manner by patients. The sensitivity values are suggested to be maximized to avoid missed diagnosis. This is particularly appropriate when the patients could be further assessed with routine ophthalmic examinations to reach a final diagnosis in clinics.
Based on these reasons, we consider a sensitivity value over 0. The diagnostic performances of each subgroup showed less diversity with newly proposed cut-off points as depicted in Table 4. Nevertheless, we need to stress that these cut-off points were derived from selected Chinese outpatients with at least one of the typical dry eye complaints.
Further studies are required to assess these proposed cut-off points for their efficacy on independent samples. Conclusion Our data suggest that the McMonnies questionnaire demonstrate poor internal consistency, fine validity, and moderate accuracy as a screening survey for dry eye in Chinese outpatients. It is recommend to become a routine process for dry eye diagnosis in the clinical practice of ophthalmologists. However, different cut-off points should be selected for various subpopulations.
Competing Interests The authors declare that there are no competing interests regarding the publication of this paper. Acknowledgments The authors acknowledge the crucial contributions of all collaborating hospitals in this study. They also appreciate all patients for their participation. This study was sponsored by Santen Pharmaceutical China Co. View at: Google Scholar J. Rege, V. Kulkarni, N. Puthran, and T.
Tan, P. Morgan, Z. Cai, and R. Glasson, F. Stapleton, and M. Cho, J. Cheon, J. Lee, S. Kim, and S. Xu and Y. View at: Google Scholar C. McMonnies and A. McMonnies, A. Ho, and D. Nichols, G. Mitchell, K. Nichols, R. Chalmers, and C. Nichols, J. Nichols, and G. Gothwal, K. Pesudovs, T. Wright, and C. Hay, E. Thomas, B. Pal, A. Hajeer, H. Chambers, and A. Schein, M. Hochberg, B. Hong, Z.
Liu, J. Hua et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Dry Eye Syndrome questionnaires
Proposed cut-off points of each group are those with the highest specificity after setting the sensitivity at a value above 0. Discussion To our knowledge, this is the first multicenter study with a large sample investigating the diagnostic efficacy of the McMonnies questionnaire. Our results suggest that the instrument shows poor internal consistency, excellent validity, and moderate discriminating ability as a screening survey for dry eye in Chinese outpatients. The McMonnies questionnaire was initially developed by reviewing literature, and scores of each item were tabulated based on clinical experience [ 10 ]. Several reports evaluating the diagnostic efficacy of the questionnaire have been published since then.
Accuracy of McMonnies Questionnaire as a Screening Tool for Chinese Ophthalmic Outpatients
All relevant data are within the paper and Supporting Information files. Methods We recruited cases from 94 hospitals research centers , randomly selected from 45 cities in 23 provinces from July to November in Only symptomatic outpatients were included and they were in a high risk of DE. Outpatients meeting the criteria filled out questionnaires and then underwent clinical examinations by qualified medical practitioners. We mainly evaluated sensitivity, specificity, diagnostic odds ratio DOR , and area under the receiver-operating characteristic curve AUC to evaluate the accuracy of the questionnaire in the diagnosis of dry eye.