OSL: A dry eye assessment algorithm


The global consensus TFOS DEWS II dry eye diagnostic test battery was developed to help provide guidance on the key outcome measures for the diagnosis and monitoring of dry eye disease in epidemiology studies and clinical trials. It was also developed to address the issues of significant methodological heterogeneity in disease definition and outcome measures in the existing literature. However, it is acknowledged that in certain resource or time-constrained settings, it might not always be feasible to conduct the diagnostic battery in its entirety, as it requires the use of several instruments and ophthalmic dyes. A recently published study conducted by the University of Auckland’s Ocular Surface Laboratory developed a rapid non-invasive dry eye assessment algorithm (see table) and evaluated its discriminative ability against the full TFOS DEWS II dry eye diagnostic test battery.

The prospective diagnostic accuracy study recruited a total of 235 participants. The findings of the study showed the areas under the receiver operating curves of all individual components of the rapid, non-invasive, assessment algorithm exceeded 0.80. At the empirically determined optimal diagnostic thresholds, the global evaluation component of the algorithm (SANDE score ≥30, and non-invasive tear film breakup time <10 s) demonstrated a sensitivity of 86%, specificity of 94%, positive likelihood ratio of 15.0 and negative likelihood ratio of 0.15.

These results would suggest that the abridged, non-invasive algorithm might serve as a useful rapid screening instrument for dry eye disease in resource or time-constrained settings.

Table: Rapid non-invasive dry eye assessment algorithm



Overall diagnosis of dry eye disease

SANDE score ≥30, and

non-invasive tear film breakup time <10s

Dry eye symptomology

SANDE score ≥30.

Dry eye signs

Non-invasive tear film breakup time <10s.

Evaporative dry eye signs

Tear film lipid layer grade ≤3.

Aqueous deficiency dry eye signs

Tear meniscus height <0.2mm.


Wang MT, Xue A, Craig JP. Screening utility of a rapid non-invasive dry eye assessment algorithm. Cont Lens Anterior Eye. 2018 (published online ahead of print). doi: 10.1016/j.clae.2018.11.009.

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