Ocular Surface Disease Index App Comparable to Paper Questionnaire

The Ocular Surface Disease Index (OSDI) is as effective as a smartphone app as it was in a conventional paper questionnaire, according to a study published in the Journal of Medical Internet Research. 

Under a contract with a Japanese university’s medical school and InnoJin Inc., the study authors developed and, in 2016, released a mobile health (mHealth) smartphone app for dry eye disease (DED). The app allows doctors to electronically gather Ocular Surface Disease Index responses, as well as medical history, blink sensing, and questionnaire responses regarding depression and work productivity.

In 2022, 33 patients (mean age, 63.6 years; 32 women) participated in a prospective study at the contracting university. After undergoing an eye exam, the patients randomly assigned to the “paper-app group,” (8 with DED) completed the paper version of the Japanese Ocular Surface Disease Index (J-OSDI), followed by the app version. The other patients (10 with DED) completed the exams in the reverse order. Between completing the 2 Ocular Surface Disease Index versions, patients completed the Dry Eye-Related Quality of Life Score (DEQS) questionnaire.

The 2 groups’ J-OSDI total scores differed by 1.8 (95% confidence interval -1.4 to 5.0). The tests were equivalent based on the minimal clinically important difference (MCID) of 7.0 points. Cronbach α coefficients for total score, ocular symptoms, vision-related function, and environmental triggers all exceeded 0.7. The intraclass correlation coefficient (ICC) values, apart from the vision-related function subscale, exceeded 0.7. Paper- and app-based J-OSDI were associated in total score and each subscale (r=0.932 total score r=0.932 ocular symptoms r=0.806 vision-related function r=0.697 environmental triggers r=0.949, P <.001 for all). Bland-Altman analysis indicated biases of 1.77 for J-OSDI total score, 4.55 for ocular symptoms, -0.64 for vision-related function, and 1.52 for environmental triggers.

“The app- and paper-based versions of the J-OSDI yielded comparable results, suggesting satisfactory performance of the app-based OSDI as a substitute for the counterpart platform,” the researchers report.

The mean difference of 1.8 between the 2 platforms was lower than a single-point change in the questionnaire, as the Japanese Ocular Surface Disease Index score increases by 2.5 increments, making the score gap clinically negligible, according to the researchers.

“Traditional patient-reported outcomes (PROs), such as paper-based questionnaires, are cumbersome for collecting daily subjective symptoms in telemedicine and web-based practice settings,” the researchers note. “Evaluating subjective symptoms through an app-based questionnaire may facilitate the implementation of telehealth in DED diagnosis, thus reducing the reliance on in-patient consultations for DED diagnosis and making follow-up simpler for susceptible populations.”

Limitations of the study include selection bias, carryover effect, and lack of comparison of each method’s efficiency.

Disclosure: Two of the study authors are the owners of InnoJin, the developer of DryEyeRhythm. One study author declared additional affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.