Ocular surface disease index questionnaire as a sensitive test for primary screening of chronic ocular graft-versus-host disease

Abstract

Background: After allogeneic hematopoietic stem cell transplantation (allo-HSCT), patients are followed up by transplant clinicians. Finding an effective primary screening method that transplant clinicians or patients can master is essential in the early referral of suspected chronic ocular graft-versus-host disease (coGVHD) to an ophthalmologist. This study investigated if the ocular surface disease index (OSDI) questionnaire could be used for coGVHD primary screening.Methods: This case-controlled, cross-sectional study enrolled 161 allo-HSCT patients. All participants completed an OSDI questionnaire and underwent a silt-lamp examination. Bulbar conjunctival injection (BCI) was assessed using torchlight, while tear volume was measured via the Schirmer test (ST). The receiver operating characteristic curve was used to evaluate the sensitivity, specificity, and cutoff values of OSDI, ST, and BCI grading. Performance comparisons of the 3 tests applied in isolation, parallel, and series were made.Results: There were 84 patients with and 77 patients without coGVHD. Compared to those without coGVHD, patients with coGVHD had significantly higher median values of OSDI, corneal fluorescein staining, conjunctival injection, conjunctival fibrosis, and meibum quality, but lower ST scores (All P values <0.001). The cutoff values for OSDI, ST, and BCI grade in the diagnosis of coGVHD were 19.4 points, 7 mm, and grade 0, respectively. The sensitivity and specificity of the tests based on the cutoff values were, respectively, 89.3% and 89.6% for OSDI, 91.7% and 59.7% for ST, and 78.6% and 70.1% for BCI. The area under the curve (AUC) value of OSDI was significantly higher than that of ST (0.931 vs. 0.826; P=0.010) and BCI grade (0.931 vs. 0.781; P<0.001). The AUC values of the combinations were lower than that of OSDI alone. Conclusions:The OSDI questionnaire can be used as a simple screening test for coGVHD as demonstrated by its high sensitivity and specificity in the transplant clinic and patients' self-monitoring. An OSDI greater than 19.4 could be considered an ophthalmology referral criterion.

Augenbeteiligung bei Graft-versus-Host-Erkrankung

“…An examination should be performed immediately when new symptoms or clinical ocular abnormalities arise. Validated self-monitoring tools are also available [35].…”

“…Eine Untersuchung sollte unmittelbar mit neu auftretenden Beschwerden oder klinischen Augenauffälligkeiten erfolgen. Es liegen zudem validierte Instrumente zum Selbstmonitoring vor 35 .…”

Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease

“…For ocular discomfort testing, the ocular surface disease index (OSDI) questionnaire – considering vision-related function, ocular symptoms, and environmental triggers—may be used ( 72 ), and daily lubricant use reported. According to a recent study, the OSDI questionnaire is a valid screening test for oGVHD in transplant clinics and for patients’ self-monitoring ( 73 ). Thus, screening intervals may be adjusted based on the results from the OSDI questionnaire.…”

Ocular manifestations and quality of life in patients after hematopoietic stem cell transplantation

“…oGVHD affects QOL in terms of general vision, ocular pain and some vision-specific activities, explaining its impact on daily activities [21] . Therefore, many doctors use QOL as a measurement of treatment efficacy in oGVHD patients [22] . Hence, we used regular ophthalmological examinations and QOL questionnaires after surgery to better explore the eye conditions of patients after ALLO-HSCT and their impact on QOL.…”