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Issue: May 10, 2018
ByMarguerite B. McDonald, MD
April 30, 2018
4 min read
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Psychometric exam valuable in evaluation of dry eye patients

Testing can begin sooner if a patient records even one dry eye or ocular surface complaint.

Issue: May 10, 2018
ByMarguerite B. McDonald, MD
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There are several reasons why it is advantageous to use a psychometric exam to evaluate dry eyes:

  1. It shortens the visit, as you already know the patient’s chief complaint(s) and the severity level.
  2. If the patient checks off even one dry eye/ocular surface complaint, it allows your technicians to proceed with dry eye tests before you enter the exam lane. If you order them after your history and slit lamp exam with proparacaine/fluorescein, it may be too late to order some of them, such as the tear osmolarity test. Ordering them after your exam requires you to return to the exam lane a second time, which we all try to avoid.
  3. Patients may sometimes forget how symptomatic they were before you started treatment; it can be useful to remind them that their psychometric scores have dramatically improved.
  4. Psychometric data can be used in marketing campaigns — “93% of our dry eye patients reported significant relief of their symptoms within 6 to 12 weeks of starting treatment.”
  5. Collecting psychometric data is useful for clinical research, should one’s practice decide to do clinical trial work.
  6. Psychometric data may be needed, in the not too distant future, to prove efficacy of treatment for insurance reimbursement (outcomes analysis).

Some practices have patients fill out the questionnaire before their visit via the practice portal or after they arrive at a kiosk in the lobby. A clipboard with an attached pen will also do nicely; the questionnaire can be scanned into the electronic medical record later by the front desk staff.

There are several validated psychometric exams that are popular nationally and internationally. There is the Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire (DEQ), McMonnies Questionnaire (MQ) and Subjective Evaluation of Symptoms of Dryness (SESoD). I would recommend a test that is validated and quite fast: the Standard Patient Evaluation of Eye Dryness (SPEED) survey.

In just eight questions, SPEED evaluates both the frequency and severity of symptoms. There is a 0 to 4 scale for the patient to rate his/her symptom severity, with 0 being no symptoms and 4 being intolerable symptoms; frequency of symptoms is rated on a scale of 0 to 3. The total score, which can range from 0 to 28, is a sum of the scores for each answer. The questions are designed to elicit responses regarding the patient’s symptoms in the present and up to 3 months prior, due to the variability of symptoms over time.

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Unfortunately, 47% of patients with significant ocular surface disease have no symptoms. Their dry eye will therefore be detected by the doctor at the slit lamp, and specific tests will then be ordered, requiring the doctor to return to the exam lane for a second time. Because ophthalmologists are not allowed have a standard battery of dry eye tests for every patient to undergo — symptomatic or not — we have to live with this situation for now, until regulations change. That is why the psychometric test is so important: It will catch the 50% of patients who are symptomatic, and the techs are allowed to test the patients before your entry to the exam lane. Hopefully, someday soon, dry eye testing will be a standard part of an annual eye exam for all patients, like measuring IOP.

Most cornea specialists and comprehensive ophthalmologists with an interest in dry eye will treat asymptomatic patients as well as symptomatic, especially if they are headed for surgery. If the surgeon finds that the patient has a very high SPEED score and/or significant findings on dry eye testing (osmolarity, meibography, tear film breakup time, etc) or slit lamp exam, the preoperative evaluation can be halted until the patient is adequately treated. If the surgeon does not have the appropriate diagnostic and therapeutic technologies, the patient can be referred to a dry eye specialist for treatment before he/she is returned to the ophthalmologist for surgery.

The dry eye specialist can be an ophthalmologist or an optometrist; they must have the appropriate diagnostic and therapeutic technologies at their disposal. If the dry eye specialist is an ophthalmologist, it must be someone who is careful to return the patient to the referring surgeon when an adequate response to treatment has been documented.

This arrangement may sound like a financial drain for the dry eye specialist, particularly if he/she is also a surgeon. This could not be further from the truth: The dry eye diagnostic and treatment technologies, such as tear osmolarity, MMP-9 testing, meibography, tear film breakup time, automated redness scoring, microblepharoexfoliation, thermal pulsation therapy and intense pulsed light treatments, are time efficient, low risk and lucrative.

In summary, a psychometric questionnaire can enhance your practice in several important ways.

  • For more information:
  • Marguerite B. McDonald, MD, FACS, can be reached at Ophthalmic Consultants of Long Island, 360 Merrick Road, Lynbrook, NY 11563; email: margueritemcdmd@aol.com.

Disclosure: McDonald reports no relevant financial disclosures regarding psychometric testing.

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