The Berkeley Dry Eye Flow Chart: A fast, functional screening instrument for contact lens-induced dryness

• Published in: PloS one Vol. 13; no. 1; p. e0190752
• Main Authors: Graham, Andrew D., Lundgrin, Erika L., Lin, Meng C.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.01.2018; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Analysis; Assessments; Biology and Life Sciences; Computer and Information Sciences; Contact lenses; Contact Lenses, Hydrophilic - adverse effects; Design; Diagnostic systems; Diagnostic tests; Earth Sciences; Ecology and Environmental Sciences; Evaluation; Eye; Eye diseases; Eye lens; Female; Flow charts; Fluorescein; Grading; Health aspects; Humans; Male; Medical research; Medical screening; Medicine and Health Sciences; Optometry; Patients; Population Groups; Questionnaires; Ratings; Reproducibility; Reproducibility of Results; Research and Analysis Methods; Researchers; Sensitivity; Sensitivity and Specificity; Studies; Tearing; Vision, Ocular; Wear; Wettability; Xerophthalmia - diagnosis; Xerophthalmia - etiology; Young Adult; United States > US; California
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0190752

In this article, we introduce a novel flow chart-based screening tool for the categorization of contact lens-induced dryness (CLIDE) and its impact on daily visual activities: the Berkeley Dry Eye Flow Chart (DEFC). One hundred thirty (130) experienced soft contact lens wearers discontinued lens wear for 24 hrs, passed a baseline screening and eye health examination, completed the Ocular Surface Disease Index (OSDI) then were dispensed fresh pairs of their habitual lenses. After 6 hrs of wear, subjects were administered a battery of symptom questionnaires, and underwent non-invasive tear breakup time (NITBUT) measurement, grading of distortion in reflected topographer mires, grading of lens surface wettability, and a fluorescein examination of the ocular surface. Subjects returned after at least 48 hrs and repeated all assessments after 6 hrs of wear of a second fresh pair of habitual lenses. The repeatability of the DEFC between visits was within 1%, and Limits of Agreement and Coefficient of Repeatability were comparable to those of the other CLIDE assessments. Higher DEFC score was significantly related to shorter pre-lens NITBUT, higher OSDI score, and higher Visual Analog Scale (VAS) ratings of average and end-of-day severity and frequency of dryness (all p < 0.001). For CLIDE as diagnosed based on DEFC score, the highest sensitivities and specificities were achieved by the OSDI and VAS ratings; pre-lens NITBUT exhibited good sensitivity but poor specificity. The optimum pre-lens NITBUT diagnostic threshold was found to be ≤ 2.0 sec for debilitating CLIDE, and the OSDI threshold was ≥ 11.4. The DEFC provides a means of quickly categorizing CLIDE patients based on severity and frequency of symptoms, and on the degree to which symptoms impact daily life. The DEFC has several potential advantages as a CLIDE screening and monitoring tool, has good repeatability, and is significantly related to commonly employed clinical assessments for CLIDE.