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Original Investigation | Clinical Sciences

Development and Validation of the Dry Eye–Related Quality-of-Life Score Questionnaire

Yuri Sakane, MD1; Masahiko Yamaguchi, MD1; Norihiko Yokoi, MD2; Miki Uchino, MD3; Murat Dogru, MD3; Takeko Oishi, PhD4,5; Yasuo Ohashi, PhD5; Yuichi Ohashi, MD1
[+] Author Affiliations
1Department of Ophthalmology, Ehime University School of Medicine, Ehime, Japan
2Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
3Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
4Public Health Research Foundation, Tokyo, Japan
5Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan
JAMA Ophthalmol. 2013;131(10):1331-1338. doi:10.1001/jamaophthalmol.2013.4503.
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Importance  A validated questionnaire that assesses symptoms and the effect of dry eye disease (DED) on the patient’s daily life is needed to evaluate the condition.

Objective  To develop and validate the Dry Eye–Related Quality-of-Life Score (DEQS) questionnaire in Japan.

Design, Setting, and Participants  Development and evaluation of the DEQS questionnaire were conducted in 4 phases: (1) item generation, (2) pilot study to assess content and face validity, (3) preliminary psychometric validation study to examine factor structure and reduce the number of items, and (4) final psychometric validation with 224 participants (203 with DED and 21 serving as controls). Participants completed the DEQS questionnaire, the Short Form-8, and the National Eye Institute Visual Function Questionnaire-25. To evaluate reproducibility and responsiveness, individuals with DED completed the DEQS questionnaire twice.

Main Outcomes and Measures  Internal consistency, reproducibility, discriminant validity, concurrent validity, and responsiveness.

Results  Items were generated from a literature review, and 35 items were selected for the draft version. In the pilot study, 11 items were deleted; furthermore, 9 items were deleted based on the results of item analysis and factor analysis in the preliminary validation study. The final 15-item DEQS questionnaire consisted of an Overall Summary scale and 2 multi-item subscales: Impact on Daily Life and Bothersome Ocular Symptoms. The psychometric analysis revealed that the DEQS questionnaire has good internal consistency, test-retest reliability, discriminant validity, and responsiveness to change. The DEQS questionnaire correlated well with the mental component of the Short Form-8 and showed strong correlations with 4 subscales (Ocular Pain, Near Vision, Distance Vision, and Mental Health) of the National Eye Institute Visual Function Questionnaire-25.

Conclusions and Relevance  The DEQS questionnaire is valid and reliable for evaluating the multifaceted effect of DED on the patient’s daily life, including mental health, and it can be used easily in routine clinical practice.

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