Cross-cultural validation of the Arabic version of the Dry Eye Questionnaire-5 (DEQ-5) scale
Keywords:
5-item Dry Eye Questionnaire, ocular surface disease index, dry eye disease, Arabic, cross-cultural validation.Abstract
Background and aim: The Dry Eye Questionnaire-5 (DEQ-5) and the Ocular Surface Disease Index (OSDI) are recommended scales by TFOS DEWS II Diagnostic Methodology report to apprehend patients with symptoms of dry eyes. Before their use, these scales must undergo a cross-cultural adaptation to the target population. The purpose of this work is to validate the Arabic version of the DEQ-5.
Methods: Forward-backward translation process was used. The reliability of the Arabic DEQ-5 was computed with Cronbach α. Discriminant validity of DEQ-5 was explored by analysis of variance with the Arabic version of the OSDI (Arabic OSDI) used as gold standard. The concurrent validity was examined by Pearson's correlation coefficient, receiver operating characteristic (ROC) curve was generated, and the cut-off of the Arabic DEQ-5 was produced. Rasch model and Exploratory Factor Analysis were performed to explore its dimentionality.
Results: The Arabic DEQ-5 met the Rasch analysis criterion of unidimensionality with an eigenvalue of the first contrast of 1.7, measurement precision of 2, and reliability of 0.8. The average scores measured by Arabic DEQ-5 in the 4 categories defined by Arabic OSDI were significantly different from each other (F=26.20, d=3, P<0.0001) except for those in the mild and moderate category. The Pearson correlation coefficient between the total scores of these questionnaires was r = 0.69 (P<0.0001), and a good agreement was reveled between them. The optimal cut-off of the Arabic DEQ-5 was 5.5.
Conclusions: Arabic DEQ-5 is a valid and reliable instrument to be used in Arab population.
References
Honavar SG. Dry Eye Disease = DED = A Disease Eluding Diagnosis. Indian J Ophthalmol. 2023 Apr;71(4):1059. doi: 10.4103/IJO.IJO_796_23
Stapleton F, Alves M, Bunya VY, et al. TFOS DEWS II Epidemiology Report. Ocul Surf. 2017 Jul 1;15(3):334–65. doi: 10.1016/j.jtos.2017.05.003
Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017 Jul 1;15(3):276–83. doi: 10.1016/j.jtos.2017.05.008
Nichols KK, Bacharach J, Holland E, et al. Impact of Dry Eye Disease on Work Productivity, and Patients’ Satisfaction With Over-the-Counter Dry Eye Treatments. Invest Ophthalmol Vis Sci. 2016 Jun 6;57(7):2975–82. doi: 10.1167/iovs.16-19419
van Tilborg MM, Murphy PJ, Evans KS. Impact of Dry Eye Symptoms and Daily Activities in a Modern Office. Optom Vis Sci. 2017 Jun;94(6):688. doi: : 10.1097/OPX.0000000000001086
Morthen MK, Magno MS, Utheim TP, et al. The vision-related burden of dry eye. Ocul Surf. 2022 Jan 1;23:207–15. doi: 10.1016/j.jtos.2021.10.007
Crane AM, Levitt RC, Felix ER, et al. Patients with more severe symptoms of neuropathic ocular pain report more frequent and severe chronic overlapping pain conditions and psychiatric disease. Br J Ophthalmol. 2017 Feb;101(2):227–31. doi: 10.1136/bjophthalmol-2015-308214
Galor A, Britten-Jones AC, Feng Y, et al. TFOS lifestyle: Impact of lifestyle challenges on the ocular surface. Ocul Surf. 2023 Apr 11;28:262–303. https://doi: 10.1016/j.jtos.2023.04.008
Asiedu K, Kyei S, Boampong F, et al. Symptomatic Dry Eye and Its Associated Factors: A Study of University Undergraduate Students in Ghana. Eye Contact Lens. 2017 Jul;43(4):262. doi: 10.1097/ICL.0000000000000256
Matossian C, McDonald M, Donaldson KE, et al. Dry Eye Disease: Consideration for Women’s Health. J Womens Health. 2019 Apr 1;28(4):502–14. doi: 10.1089/jwh.2018.7041
Sullivan DA, Rocha EM, Aragona P, et al. TFOS DEWS II Sex, Gender, and Hormones Report. Ocul Surf. 2017 Jul;15(3):284–333. doi: 10.1016/j.jtos.2017.04.001
Chan TCY, Chow SSW, Wan KHN, et al. Update on the association between dry eye disease and meibomian gland dysfunction. Hong Kong Med J Xianggang Yi Xue Za Zhi. 2019 Feb;25(1):38–47. doi: 10.12809/hkmj187331
Mirza E, Oltulu R, Oltulu P, et al. Dry eye disease and ocular surface characteristics in patients with keratoconus. Saudi J Ophthalmol. 2022 Jul 11;36(1):117–21. doi: 10.4103/sjopt.sjopt_37_21
Trattler W, Karpecki P, Rapoport Y, et al. The Prevalence of Demodex Blepharitis in US Eye Care Clinic Patients as Determined by Collarettes: A Pathognomonic Sign. Clin Ophthalmol. 2022 Dec 31;16:1153–64. doi: 10.2147/OPTH.S354692
Begley CG, Chalmers RL, Mitchell GL, et al. Characterization of Ocular Surface Symptoms From Optometric Practices in North America. Cornea. 2001 Aug;20(6):610.
Wolffsohn JS, Arita R, Chalmers R, et al. TFOS DEWS II Diagnostic Methodology report. Ocul Surf. 2017 Jul 1;15(3):539–74. doi: 10.1016/j.jtos.2017.05.001
Okumura Y, Inomata T, Iwata N, et al. A Review of Dry Eye Questionnaires: Measuring Patient-Reported Outcomes and Health-Related Quality of Life. Diagnostics. 2020 Aug;10(8):559. doi: 10.3390/diagnostics10080559
Bakkar MM, El-Sharif AK, Al Qadire M. Validation of the Arabic version of the Ocular Surface Disease Index Questionnaire. Int J Ophthalmol. 2021;14(10):1595–601. doi: 10.18240/ijo.2021.10.18
Chalmers RL, Begley CG, Caffery B. Validation of the 5-Item Dry Eye Questionnaire (DEQ-5): Discrimination across self-assessed severity and aqueous tear deficient dry eye diagnoses. Contact Lens Anterior Eye. 2010 Apr 1;33(2):55–60. doi: 10.1016/j.clae.2009.12.010
Martinez JD, Galor A, Amescua G, et al. Transcultural validation of the 5-Item Dry Eye Questionnaire for the Mexican population. Int Ophthalmol. 2019 Oct;39(10):2313–24. doi: 10.1007/s10792-018-01068-3
Goya MC, Traipe L, Bahamondes R, et al. Adaptation culturally and linguistically to the Chilean population and validation the Dry Eye Questionnaire 5. Arch Soc Espanola Oftalmol. 2023 Mar 22;S2173-5794(23)00034-8. doi: 10.1016/j.oftale.2023.01.004
Gross LG, Pozzebon ME, Favarato AP, et al. Translation and validation of the 5-Item Dry Eye Questionnaire into Portuguese. Arq Bras Oftalmol. 2022 Nov 4:S0004-27492022005011218. doi: 10.5935/0004-2749.2022-0197.
Sousa VD, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline: Validation of instruments or scales. J Eval Clin Pract. 2011 Apr;17(2):268–74. doi: 10.1111/j.1365-2753.2010.01434.x
Schiffman RM, Christianson MD, Jacobsen G, et al. Reliability and Validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000 May 1;118(5):615–21. doi:10.1001/archopht.118.5.615
Akowuah PK, Adjei-Anang J, Nkansah EK, et al. Comparison of the performance of the dry eye questionnaire (DEQ-5) to the ocular surface disease index in a non-clinical population. Contact Lens Anterior Eye J Br Contact Lens Assoc. 2022 Jun;45(3):101441. doi: 10.1016/j.clae.2021.101441
Anthoine E, Moret L, Regnault A, et al. Sample size used to validate a scale: a review of publications on newly-developed patient reported outcomes measures. Health Qual Life Outcomes. 2014 Dec 9;12:2. doi: 10.1186/s12955-014-0176-2
Hair JF, Babin BJ, Black WC, et al. Multivariate Data Analysis. Cengage; 2019. 813 p.
Gabe KT, Jaime PC. Development and testing of a scale to evaluate diet according to the recommendations of the Dietary Guidelines for the Brazilian Population. Public Health Nutr. 2019 Apr;22(5):785-796. doi: 10.1017/S1368980018004123.
Ilechie A, Mensah T, Abraham CH, et al. Assessment of four validated questionnaires for screening of dry eye disease in an African cohort. Contact Lens Anterior Eye. 2022 Apr;45(2):101468. doi: 10.1016/j.clae.2021.101468
Pucker AD, Dougherty BE, Jones-Jordan LA, et al. Psychometric Analysis of the SPEED Questionnaire and CLDEQ-8. Invest Ophthalmol Vis Sci. 2018 Jul 5;59(8):3307–13. doi: 10.1167/iovs.18-24016
Aryadoust V, Ng LY, Sayama H. A comprehensive review of Rasch measurement in language assessment: Recommendations and guidelines for research. Lang Test. 2021 Jan 1;38(1):6–40. doi: 10.1177/0265532220927487
Taherdoost H, Sahibuddin S, Jalaliyoon N. Exploratory factor analysis; concepts and theory. Adv Appl Pure Math. 2022;27:375–82.
Pult H, Wolffsohn JS. The development and evaluation of the new Ocular Surface Disease Index-6. Ocul Surf. 2019 Oct;17(4):817–21. doi: 10.1016/j.jtos.2019.08.008
Chatterjee S, Agrawal D, Chaturvedi P. Ocular Surface Disease Index© and the five-item dry eye questionnaire: A comparison in Indian patients with dry eye disease. Indian J Ophthalmol. 2021 Sep;69(9):2396–400. doi: 10.4103/ijo.IJO_3345_20
Dana R, Meunier J, Markowitz JT, et al. Patient-Reported Burden of Dry Eye Disease in the United States: Results of an Online Cross-Sectional Survey. Am J Ophthalmol. 2020 Aug 1;216:7–17. doi: 10.1016/j.ajo.2020.03.044
Tonkerdmongkol D, Poyomtip T, Poolsanam C, et al. Prevalence and associated factors for self-reported symptoms of dry eye among Thai school children during the COVID-19 outbreak. PLOS ONE. 2023 Apr 24;18(4):e0284928. doi: 10.1371/journal.pone.0284928
Kim DW, Seo JH, Lim SH. Evaluation of ocular surface disease in elderly patients with glaucoma: expression of matrix metalloproteinase-9 in tears. Eye. 2021 Mar;35(3):892–900. doi: 10.1038/s41433-020-0993-y
Han G, Lim DH, Yoo YS, et al. Transcutaneous Electrical Stimulation for the Prevention of Dry Eye Disease after Photorefractive Keratectomy. Ophthalmol Sci. 2022 Nov 2;3(2):100242. doi: 10.1016/j.xops.2022.100242
Caffery B, Srinivasan S, Reaume CJ, et al. Prevalence of dry eye disease in Ontario, Canada: A population-based survey. Ocul Surf. 2019 Jul 1;17(3):526–31. doi: 10.1016/j.jtos.2019.02.011
Bakkar MM, Shihadeh WA, Haddad MF, et al. Epidemiology of symptoms of dry eye disease (DED) in Jordan: A cross-sectional non-clinical population-based study. Contact Lens Anterior Eye. 2016 Jun 1;39(3):197–202. doi: 10.1016/j.clae.2016.01.003
Sherry A, Aridi M, Ghach W. Prevalence and risk factors of symptomatic dry eye disease in Lebanon. Contact Lens Anterior Eye J Br Contact Lens Assoc. 2020 Aug;43(4):355–8. doi: 10.1016/j.clae.2019.08.001
Shanti Y, Shehada R, Bakkar MM, et al. Prevalence and associated risk factors of dry eye disease in 16 northern West bank towns in Palestine: a cross-sectional study. BMC Ophthalmol. 2020 Jan 13;20:26. doi: 10.1186/s12886-019-1290-z
Simpson TL, Situ P, Jones LW, et al. Dry Eye Symptoms Assessed by Four Questionnaires. Optom Vis Sci. 2008 Aug;85(8):E692. doi: 10.1097/OPX.0b013e318181ae36
Hoo ZH, Candlish J, Teare D. What is an ROC curve? Emerg Med J. 2017 Jun;34(6):357–9. doi: 10.1136/emermed-2017-206735
McHugh ML. Interrater reliability: the kappa statistic. Biochem Medica. 2012 Oct 15;22(3):276–82.
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