Comparison of the NEI-VFQ and OSDI questionnaires in patients with Sjögren's syndrome-related dry eye
To examine the associations between vision-targeted health-related quality of life (VT-HRQ) and ocular surface parameters in patients with Sjögren's syndrome, a systemic autoimmune disease characterized by dry eye and dry mouth.
Forty-two patients fulfilling European / American diagnostic criteria for Sjögren's syndrome underwent Schirmer testing without anesthesia, ocular surface vital dye staining; and measurement of tear film breakup time (TBUT). Subjects were administered the Ocular Surface Disease Index (OSDI) and the 25-item National Eye Institute Vision Functioning Questionnaire (NEI-VFQ). Main outcome measures included ocular surface parameters, OSDI subscales describing ocular discomfort (OSDI-symptoms), vision-related function (OSDI-function), and environmental triggers, and NEI-VFQ subscales.
Participants (aged 31–81 y; 95% female) all had moderate to severe dry eye. Associations of OSDI subscales with the ocular parameters were modest (Spearman r (ρ) < 0.22) and not statistically significant. Associations of NEI-VFQ subscales with the ocular parameters reached borderline significance for the near vision subscale with TBUT (ρ = 0.32, p = .05) and for the distance vision subscale with van Bijsterveld score (ρ = 0.33, p = .04). The strongest associations of the two questionnaires were for: ocular pain and mental function with OSDI-symptoms (ρ = 0.60 and 0.45, respectively); and general vision, ocular pain, mental function, role function, and driving with OSDI-function (ρ = 0.60, 0.50, 0.61, 0.64, 0.57, and 0.67, respectively).
Associations between conventional objective measures of dry eye and VT-HRQ were modest. The generic NEI-VFQ was similar to the disease-specific OSDI in its ability to measure the impact of Sjögren's syndrome-related dry eye on VT-HRQ.
- Brewitt, H, Sistani, F (2001) Dry eye disease: the scale of the problem. Surv Ophthalmol 45: pp. S199-S202 CrossRef
- Schein, OD, Munoz, B, Tielsch, JM, Bandeen-Roche, K, West, S (1997) Prevalence of dry eye among the elderly. Am J Ophthalmol 124: pp. 723-728
- McCarty, CA, Bansal, AK, Livingston, PM, Stanislavsky, YL, Taylor, HR (1998) The epidemiology of dry eye in Melbourne, Australia. Ophthalmology 105: pp. 1114-1119 CrossRef
- Moss, SE, Klein, R, Klein, BE (2000) Prevalence of and risk factors for dry eye syndrome. Arch Ophthalmol 118: pp. 1264-1268
- Chia, EM, Mitchell, P, Rochtchina, E, Lee, AJ, Maroun, R, Wang, JJ (2003) Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains Eye Study. Clin Experimental Ophthalmol 31: pp. 229-232 CrossRef
- Schaumberg, DA, Sullivan, DA, Buring, JE, Dana, MR (2003) Prevalence of dry eye syndrome among U.S. women. Am J Ophthalmol 136: pp. 318-326 CrossRef
- Nelson, JD, Helms, H, Fiscella, R, Southwell, Y, Hirsch, JD (2000) A new look at dry eye disease and its treatment. Adv Ther 17: pp. 84-93 CrossRef
- Lemp, MA (1987) Recent developments in dry eye management. Ophthalmology 94: pp. 1299-1304
- Goto, E, Yagi, Y, Matsumoto, Y, Tsubota, K (2002) Impaired functional visual acuity of dry eye patients. Am J Ophthalmol 133: pp. 181-186 CrossRef
- Sade de Paiva, C, Luiz Lindsey, J, Pflugfelder, SC (2003) Assessing the severity of keratitis sicca with videokeratoscopic indices. Ophthalmology 110: pp. 1102-1109 CrossRef
- Vitale, S, Schein, OD (2003) Qualitative research in functional vision. Int Ophthalmol Clin 43: pp. 17-30
- Damiano, AM, Steinberg, EP, Cassard, SD, Bass, EB, Diener-West, M, Legro, MW, Tielsch, J, Schein, OD, Javitt, J, Kolb, M (1995) Comparison of generic versus disease-specific measures of functional impairment in patients with cataract. Med Care 33: pp. AS120-130
- Patrick, DL, Deyo, RA (1989) Generic and disease-specific measures in assessing health status and quality of life. Med Care 27: pp. S217-232 CrossRef
- Ware, JE Measures for a new era of health assessment. In: Stewart, AL, Ware, JE eds. (1992) In Measuring Functioning and Well-Being. The Medical Outcomes Study Approach. The RAND Corporation, Duke University Press, pp. 6-7
- Patrick, DL, Erickson, P (1993) Health Status and Health Policy. Allocating Resources to Health Care.
- Barofsky, I (2001) Health-related quality of life: methods of assessment. Horm Res 56: pp. 51-54 CrossRef
- McMonnies, CW (1986) Key questions in a dry eye history. J Am Optom Assoc 57: pp. 512-517
- Hay, EM, Thomas, E, Pal, B, Hajeer, A, Chambers, H, Silman, AJ (1998) Weak association between subjective symptoms or and objective testing for dry eyes and dry mouth: results from a population based study. Ann Rheum Dis 57: pp. 20-24 CrossRef
- Schein, OD, Tielsch, JM, Munoz, B, Bandeen-Roche, K, West, S (1997) Relation between signs and symptoms of dry eye in the elderly. A population-based perspective. Ophthalmology 104: pp. 1395-1401
- Bjerrum, KB (1996) Test and symptoms in keratoconjunctivitis sicca and their correlation. Acta Ophthalmol Scand 74: pp. 436-441 CrossRef
- Begley, CG, Caffery, B, Chalmers, RL, Mitchell, GL (2002) Use of the Dry Eye Questionnaire to measure symptoms of ocular irritation in patients with aqueous tear deficient dry eye. Cornea 21: pp. 664-670 CrossRef
- Bandeen-Roche, K, Munoz, B, Tielsch, JM, West, SK, Schein, OD (1997) Self-reported assessment of dry eye in a population-based setting. Invest Ophthalmol Vis Sci 38: pp. 2469-2475
- Oden, NL, Lilienfeld, DE, Lemp, MA, Nelson, JD, Ederer, F (1998) Sensitivity and specificity of a screening questionnaire for dry eye. Adv Exp Med Biol 438: pp. 807-820
- Schiffman, RM, Christianson, MD, Jacobsen, G, Hirsch, JD, Reis, BL (2000) Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol 118: pp. 615-621
- Fox, RI, Michelson, P, Casiano, CA, Hayashi, J, Stern, M (2000) Sjögren's syndrome. Clin Dermatol 18: pp. 589-600 CrossRef
- Friedlaender, MH (1992) Ocular manifestations of Sjögren's syndrome: keratoconjunctivitis sicca. Rheum Dis Clin North Am 18: pp. 591-608
- Fox, RI, Stern, M, Michelson, P (2000) Update in Sjögren syndrome. Curr Opin Rheumatol 12: pp. 391-398 CrossRef
- Sjögren's syndrome.
- Pedersen, AM, Nauntofte, B (2001) Primary Sjögren's syndrome: oral aspects on pathogenesis, diagnostic criteria, clinical features and approaches for therapy. Expert Opin Pharmacother 2: pp. 1415-1436 CrossRef
- Bell M, Askari A, Bookman A, Frydrych S, Lamont J, McComb J, Muscoplat C, Slomovic A: Sjögren's syndrome: a critical review of clinical management. J Rheumatol 26:2051–2061.
- Brun, JG, Madland, TM, Jonsson, R (2003) A prospective study of sicca symptoms in patients with rheumatoid arthritis. Arthritis & Rheumatism 49: pp. 187-192 CrossRef
- Kalk, WW, Mansour, K, Vissink, A, Spijkervet, FK, Bootsma, H, Kallenberg, CG, Roodenburg, JL, Nieuw Amerongen, AV (2002) Oral and ocular manifestations in Sjögren's syndrome. J Rheumatol 29: pp. 924-930
- Kruize, AA, Bijsterveld, OP, Hene, RJ, Wilde, PC, Feltkamp, TE, Kater, L, Bijlsma, JW (1997) Long-term course of tear gland function in patients with keratoconjunctivitis sicca and Sjögren's syndrome. Br J Ophthalmol 81: pp. 435-438 CrossRef
- Rostron, J, Rogers, S, Longman, L, Kaney, S, Field, EA (2002) Health-related quality of life in patients with primary Sjögren's syndrome and xerostomia: a comparative study. Gerodontology 19: pp. 53-59 CrossRef
- Hay, KD, Morton, RP, Wall, CR (2001) Quality of life and nutritional studies in Sjögren's syndrome patients with xerostomia. N Z Dent J 97: pp. 128-131
- Valtysdottir, ST, Gudbjornsson, B, Hallgren, R, Hetta, J (2000) Psychological well-being in patients with primary Sjögren's syndrome. Clin Exp Rheumatol 18: pp. 597-600
- Strombeck, B, Ekdahl, C, Manthorpe, R, Wikstrom, I, Jacobsson, L (2000) Health-related quality of life in primary Sjögren's syndrome, rheumatoid arthritis and fibromyalgia compared to normal population data using SF-36. Scand J Rheumatol 29: pp. 20-28 CrossRef
- Valtysdottir, ST, Gudbjornsson, B, Lindqvist, U, Hallgren, R, Hetta, J (2000) Anxiety and depression in patients with primary Sjögren's syndrome. J Rheumatol 27: pp. 165-169
- Thomas, E, Hay, EM, Hajeer, A, Silman, AJ (1998) Sjögren's syndrome: a community-based study of prevalence and impact. Br J Rheumatol 37: pp. 1069-1076 CrossRef
- Sutcliffe, N, Stoll, T, Pyke, S, Isenberg, DA (1998) Functional disability and end organ damage in patients with systemic lupus erythematosus (SLE), SLE and Sjögren's syndrome (SS), and primary SS. J Rheumatol 25: pp. 63-68
- Mangione, CM, Lee, PP, Pitts, J, Gutierrez, P, Berry, S, Hays, RD (1998) Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ). Arch Ophthalmol 116: pp. 1496-1504
- Mangione, CM, Lee, PP, Gutierrez, PR, Spritzer, K, Berry, S, Hays, RD (2001) Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol 119: pp. 1050-1058
- RAND Corporation: The VFQ. [http://www.rand.org/health/surveys/vfq25/scoring.pdf]
- Lemp, MA (2000) Evaluation and differential diagnosis of keratoconjunctivitis sicca. J Rheumatol Suppl 61: pp. 11-14
- Vitali, C, Moutsopoulos, HM, Bombardieri, S (1994) The European Community Study Group on diagnostic criteria for Sjögren's syndrome. Sensitivity and specificity of tests for ocular and oral involvement in Sjögren's syndrome. Ann Rheum Dis 53: pp. 637-647 CrossRef
- Bron, AJ (1997) The Doyne Lecture. Reflections on the tears. Eye 11: pp. 583-602
- Bijsterveld, OP (1969) Diagnostic tests in the sicca syndrome. Arch Ophthalmol 82: pp. 10-14
- Pflugfelder, SC, Tseng, SC, Sanabria, O, Kell, H, Garcia, CG, Felix, C, Feuer, W, Reis, BL (1998) Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea 17: pp. 38-56 CrossRef
- Vitali, C, Bombardieri, S, Jonsson, R, Moutsopoulos, HM, Alexander, EL, Carsons, SE, Daniels, TE, Fox, PC, Fox, RI, Kassan, SS, Pillemer, SR, Talal, N, Weisman, MH (2002) Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 61: pp. 554-558 CrossRef
- Armitage, P, Berry, G (1994) Statistical Methods in Medical Research.
- Kahn, HA, Sempos, CT (1989) Statistical Methods in Epidemiology. Monographs in Epidemiology and Biostatistics 12: pp. 137-147
- Rolando, M, Iester, M, Macri, A, Calabria, G (1998) Low spatial-contrast sensitivity in dry eyes. Cornea 17: pp. 376-379 CrossRef
- Shiotani, Y, Maeda, N, Inoue, T, Watanabe, H, Inoue, Y, Shimomura, Y, Tano, Y (2000) Comparison of topographic indices that correlate with visual acuity in videokeratography. Ophthalmology 107: pp. 559-564 CrossRef
- Sall, K, Stevenson, OD, Mindorf, TK, Reis, BL (2000) Two multicenter randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. Ophthalmology 107: pp. 631-639 CrossRef
- Martin, XY, Safran, AB (1988) Corneal hypoesthesia. Surv Ophthalmol 33: pp. 28-40 CrossRef
- Shimazaki, J, Goto, E, Ono, M, Shimmura, S, Tsubota, K (1998) Meibomian gland dysfunction in patients with Sjögren's syndrome. Ophthalmology 105: pp. 1485-1488 CrossRef
- Comparison of the NEI-VFQ and OSDI questionnaires in patients with Sjögren's syndrome-related dry eye
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Health and Quality of Life Outcomes
- Online Date
- September 2004
- Online ISSN
- BioMed Central
- Additional Links
- Author Affiliations
- 1. Division of Epidemiology and Clinical Research, National Eye Institute, Building 31, room 6A52, 31 Center Drive, MSC 2510, Bethesda, Maryland, USA
- 2. Clinical Center, National Institutes of Health, Bethesda, Maryland, USA