Transcultural validation of the 5-Item Dry Eye Questionnaire for the Mexican population

  • Jaime D. Martinez
  • Anat Galor
  • Guillermo Amescua
  • Nallely Ramos-Betancourt
  • Francisco Beltrán
  • Alejandro Babayán Sosa
  • Concepción Santacruz Valdés
  • Cecilia Ramírez-Assad
  • Elsa Mora Juárez
  • Everardo Hernández-QuintelaEmail author
Original Paper



To translate and validate a Spanish-language adaptation of the 5-Item Dry Eye Questionnaire for the Mexican population.


Based on the MAPI Institute guidelines, the linguistic validation procedures consisted of four steps. Every step was reviewed by the committee. The translated validated questionnaire was applied to 25 Mexican subjects. The questionnaires were completed by the same subjects at three time points, 8 h apart on the same day and then 3 days later. Sensitivity and specificity of the DEQ-5 to predict DE signs was subsequently estimated in 200 patients see in the Asociación para Evitar la Ceguera ophthalmology clinic.


During the forward translation step analysis, the committee decided to change the severity scale, as the words “constantly” and “frequently” are synonymous in Spanish, so it was modified by changing “constantly” to “always” for better understanding. Overall, the intra-test intra-class correlation coefficient from tests administered on the same day was 0.9 (95% CI 0.77–0.95, p = 0.0005). The intra-test intra-class correlation coefficient from tests administered 3 days apart was 0.9 (95% CI 0.88–0.97, p = 0.0005). When applying the questionnaire to 200 patients seen in an eye clinic, we found a sensitivity of 76% and a specificity of 31% for a DEQ-5 score of ≥ 6, against 2 or more positive signs of dry eye.


MAPI methodology proved to be a reliable strategy for the transcultural Dry Eye Questionnaire for translation from English to Spanish for the Mexican population.


Dry eye questionnaire Ocular surface disease Dry eye disease 



This study was supported by the Pan-American association of Ophthalmology (PAAO) and Retina Research Foundation (JD Martinez), and the study was also supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research EPID-006-15S (Dr. Galor), R01EY026174 (Dr. Galor), NIH Center Core Grant P30EY014801, and Research to Prevent Blindness Unrestricted Grant.

Compliance with ethical standards

Conflict of interest

No author has a conflict of interest to report.

Supplementary material

10792_2018_1068_MOESM1_ESM.xlsx (36 kb)
Supplementary material 1 (xlsx 37 kb)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Jaime D. Martinez
    • 1
    • 3
    • 9
  • Anat Galor
    • 2
    • 3
  • Guillermo Amescua
    • 3
  • Nallely Ramos-Betancourt
    • 1
    • 9
  • Francisco Beltrán
    • 1
    • 9
  • Alejandro Babayán Sosa
    • 4
    • 9
  • Concepción Santacruz Valdés
    • 5
    • 9
  • Cecilia Ramírez-Assad
    • 6
  • Elsa Mora Juárez
    • 7
  • Everardo Hernández-Quintela
    • 1
    • 8
    • 9
    Email author
  1. 1.Cornea and Refractive Surgery Department, Asociación Para Evitar la Ceguera (APEC)Universidad Nacional Autónoma de MéxicoMéxico CityMéxico
  2. 2.Ophthalmology DepartmentMiami Veterans Affairs Medical CenterMiamiUSA
  3. 3.Cornea and Ocular Surface Service, Bascom Palmer Eye InstituteUniversity of MiamiMiamiUSA
  4. 4.Cornea and Refractive Surgery DepartmentFundación Hospital “Nuestra Señora de la Luz” IAPMéxico CityMéxico
  5. 5.Cornea and Refractive Surgery DepartmentInstituto de Oftalmología Fundación Conde de ValencianaMéxico CityMéxico
  6. 6.Rheumatology and Systemic VasculitisHospital Christus Muguerza SaltilloCoahuilaMéxico
  7. 7.Psychology DepartmentAsociación Para Evitar la Ceguera (APEC)México CityMéxico
  8. 8.Sigma Delta Health Systems, S.C.México CityMéxico
  9. 9.CICV MARVO (Colegio de Investigación en Ciencias Visuales, MARVO)México CityMéxico

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