Eyeworld

EW CORNEA 42 January 2019 Editors' note: The sources have no financial interests related to their comments. Contact information Al-Aswad: jr3674@cumc.columbia.edu Petris: rebecca@dryeyecompany.com Saldanha: ian_saldanha@brown.edu Shigeyasu: shigeyasu@eye-center.org based on demonstrated evidence of improvement in the things that matter the most to patients." "This study emphasizes the need to consider patients as partners in disease understanding and man- agement," said Lama Al-Aswad, MD, MPH, associate professor of ophthalmology, Columbia Universi- ty Medical Center, New York. Although the study focused on research outcomes, there are also potential implications in practice. "The study confirms the importance of listening to patients and under- standing their symptoms and con- cerns. Treatment should be geared to the underlying cause and give a special focus to their symptoms and concerns," Dr. Al-Aswad said. Physicians treating dry eye should keep patient concerns in mind, Dr. Saldanha said. "Our paper can add information and context to the clinical signs that the practi- tioner observes," he added. Ms. Petris said that she urges dry eye patients to discuss with physicians how dry eye symptoms affect their life. For example, she encourages them to use the Ocular Surface Disease Index smartphone app to report their symptoms. Although Chika Shigeyasu, MD, Department of Ophthalmol- ogy, Kyorin University School of Medicine, Tokyo, Japan, agreed that patient symptoms are necessary, physicians should strike a balance. "I do think the qualitative evalu- ation of dry eye by clinical tests is still important. I think a combina- tion of tests should be performed, in addition to subjective symptoms in clinical practice," Dr. Shigeya- su said. Dr. Shigeyasu recently led another study that measured quality of life among dry eye subgroups (see sidebar). Dr. Saldanha is working with other researchers to identify core outcomes that should be a priority in future dry eye research, based on the 28 outcomes identified in the current study; they also recently published a commentary on this topic. 3 "The objective is for those outcomes to then be considered a minimum or core set that all future research will measure. Then, if that objective is met and the core outcome sets are adhered to, we will have common yardsticks with which to evaluate and compare treatments," he said. "Researchers can use the 8 research questions identified by both clinicians and patients as important to guide future research," Dr. Saldanha added. EW References 1. Saldanha IJ, et al. Research questions and outcomes prioritized by patients with dry eye. JAMA Ophthalmol. 2018;136:1170–1179. 2. Saldanha IJ, et al. Gaps in current knowl- edge and priorities for future research in dry eye. Cornea. 2017;36:1584–1591. 3. Saldanha IJ, et al. Choosing core outcomes for use in clinical trials in ophthalmology: per- spectives from three ophthalmology outcomes working groups. Ophthalmology. 2018. Article in press. 4. Shigeyasu C, et al. Qualify of life mea- sures and health utility values among dry eye subgroups. Health Qual Life Outcomes. 2018;16:170. Focusing continued from page 40 Similar quality of life among dry eye subgroups A study from Japan that compared quality of life and health util- ity among dry eye patients with short tear film breakup time (TBUT) with minimal clinical signs versus those with aqueous deficient dry eye found similar results in both groups. 4 The study was led by Dr. Shigeyasu, Dr. Masakazu Yamada, and co-researchers. The research included 449 adult patients with dry eye who had ophthalmic examinations and were evaluated with the Dry Eye-Related Quality of Life Score (DEQS), which uses 0 as the best score and 100 as the worst. The Health Utilities Index Mark 3 was also completed. There were no significant between-group differences with the questionnaires. Researchers found a weak significant correlation among TBUT, corneal staining score, and keratoconjunctival stain- ing score to the DEQS. "Our findings suggest that clinicians should be aware of the impact of short tear film breakup time dry eye on patients' qualify of life and utility values," the researchers concluded.

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