Test combination important in diagnosing ocular surface disease
Relying solely on a single test for dry eye disease diagnosis carries a significant risk of misdiagnosis, according to a new study. Even adhering to the minimum TFOS DEWS II criterion of symptoms plus any single test of tear film homeostasis was shown to have limitations.
To minimize this risk, the study recommended performing a comprehensive battery of tests and utilizing the collective results to inform the diagnosis process. Moreover, the simultaneous occurrence of conjunctival and corneal staining was highlighted as a crucial outcome that should be specified in future diagnostic guidelines.
The study sought to determine how the likelihood of making a correct diagnosis of dry eye disease varies according to the clinical test methods used. The research specifically focused on calculating the probability of accurately diagnosing dry eye disease given a positive test result. The team utilized the Bayes-Price rule to calculate this probability for a range of standard tests commonly employed for dry eye diagnosis.
At an assumed prevalence of 11.6%, the study found varying probabilities of correct diagnosis for different individual tests. Corneal staining emerged as the single test with the highest probability of correct diagnosis (probability = 0.28), while the ocular surface disease index (OSDI) exhibited the lowest probability (0.14).
The research emphasized the significance of combining symptoms and tests for more accurate diagnosis. The combination of the 5-item dry eye questionnaire (DEQ-5) and corneal staining demonstrated the highest probability (0.42) of accurate diagnosis for tear film homeostasis. On the other hand, the combination of OSDI and tear film break-up time (TBUT) yielded the lowest probability (0.23).
A notable finding was that the simultaneous observation of conjunctival and corneal staining was associated with a substantially higher probability of a correct diagnosis (0.49).
The study also highlighted the cumulative effect of positive test results on the accuracy of diagnosis. The probability of a correct diagnosis increased with the number of positive tests, reaching a maximum of 0.90 when all of DEQ-5, conjunctival and corneal staining, osmolarity, and TBUT were positive.
Reference
Papas EB. Diagnosing dry-eye: Which tests are most accurate? Cont Lens Anterior Eye. 2023;102048. doi: 10.1016/j.clae.2023.102048. Epub ahead of print. PMID: 37544866.
