For each individual, demographic information (age, sex, race, ethnicity), past ocular and medical history, and medication information were collected. Medications were categorized into anxiolytics, antidepressants, analgesics, antihistamines, and the gabapentinoids.
Patients filled out standardized questionnaires regarding dry eye symptoms, including the Dry Eye Questionnaire 5 (DEQ5)
22 (link) and the Ocular Surface Disease Index (OSDI).
23 (link) The DEQ5 is a validated, five-item questionnaire that combines patient responses regarding “eye discomfort” (frequency and intensity), “eye dryness” (frequency and intensity), and “watery eyes” (frequency) during the past month. Scores on the DEQ5 can range from 0 to 22, with higher scores indicating greater severity of symptoms. The OSDI is a 12-item questionnaire that assesses the frequency of dry eye symptoms and their impact on function on a 0 to 100 scale, with higher scores indicating greater severity of disease.
23 (link) It has good psychometric properties
23 (link) and has been used in a number of studies of dry eye and quality of life.
24 (link),25 (link)Pain questionnaires were used to assess for the presence and quality of ocular pain. A numerical rating scale (NRS; score 0–10) was used to assess the “average intensity of eye pain during the past week.” The Neuropathic Pain Symptom Inventory (NPSI),
26 (link) modified for the eye, was used to quantify the severity of clinically relevant dimensions of neuropathic pain. This questionnaire was chosen as it has been validated and used in a number of patient populations with various neuropathic pain conditions,
26 (link)–30 (link, link, link, link) though it has not been specifically validated for eye pain. The NPSI consists of 10 scored items that help identify and assess the severity of spontaneous and paroxysmal pain, paresthesias, allodynia, and hyperalgesia. In order to modify the NPSI so that it was relevant to neuropathic ocular pain (NOP), we replaced three of the original questions regarding the severity of allodynia or hyperalgesia caused by (1) light touch, (2) pressure, or (3) contact with something cold on the skin, with questions specific to ocular allodynia or hyperalgesia (eye pain caused or increased by [1] wind, [2] light, and [3] heat or cold). A total NPSI eye score was calculated, along with five subscores (burning spontaneous pain, pressing spontaneous pain, paroxysmal pain, evoked pain, and paresthesia/dysesthesia), as an indication of the severity of neuropathic-like ocular pain.
Regarding mental health indices, symptoms of PTSD were assessed via the PTSD Checklist–Military Version (PCL-M) (score 17–85)
31 (link),32 (link) and symptoms of depression via the Patient Health Questionnaire 9 (PHQ9) (score 0–27).
33 (link)
Spierer O., Felix E.R., McClellan A.L., Parel J.M., Gonzalez A., Feuer W.J., Sarantopoulos C.D., Levitt R.C., Ehrmann K, & Galor A. (2016). Corneal Mechanical Thresholds Negatively Associate With Dry Eye and Ocular Pain Symptoms. Investigative Ophthalmology & Visual Science, 57(2), 617-625.