Key takeaways:

• Researchers concluded that neither the DEQ-5 nor the modified OSDI adequately captured pediatric dry eye symptoms.
• A valid and repeatable assessment instrument is still needed.

Dry eye symptoms in children may not be adequately captured by the Dry Eye Questionnaire or a modified version of the Ocular Surface Disease Index, according to a study published in Optometry and Vision Science.

“Interestingly, especially associated with prolonged screen time, more recent studies have concluded that the prevalence of dry eye disease in children is actually close to that in adults,” Yi Pang, OD, PhD, FAAO, associate dean for research at Illinois College of Optometry, and colleagues wrote. “Given the increasing prevalence of dry eye disease in children, there is an urgency to identify a valid and reliable questionnaire to evaluate dry eye symptoms in this population.”

Dry eye symptoms in children may not be adequately captured by the Dry Eye Questionnaire or a modified version of the Ocular Surface Disease Index. Image: Adobe Stock

To evaluate the performance of the Dry Eye Questionnaire (DEQ-5) and a modified version of the OSDI in children, Pang and colleagues conducted a study of 225 children who were seen at the pediatric clinic of Illinois Eye Institute from June 2023 to June 2025. Participants were 12.4 years old on average and 44% Black.

The researchers surveyed each child about dry eye symptoms with both the DEQ-5 and modified OSDI in randomized order. They kept track of whether the children had difficulty understanding the questions and retested 72 of them with both questionnaires to evaluate their repeatability. The performance of each survey was evaluated using Rasch analysis.

Using receiver operating characteristic curve analysis, a DEQ-5 cutoff score of five or more was determined to be optimal in children vs. the cutoff score of six used for adults. The researchers wrote that they “do not recommend” using the DEQ-5 in children overall.

Rasch analysis showed that the fifth question, which asked children how often they experienced “watery eyes” over the last month, performed the opposite of what was expected: those who reported fewer symptoms on other questions reported more symptoms on this question.

The researchers recommended omitting this question for pediatric patients. But even after removing it, the DEQ-5 still performed “poorly,” they wrote.

Rasch analysis of the modified OSDI showed that children were “unable to accurately differentiate” between adjacent responses in the five-level response scale.

“Acceptable targeting in children was achieved in our study only when response categories were collapsed into a three-category response structure,” they wrote. “However, caution should be used when providing fewer response categories since it may reduce the ability to classify levels of dry eye symptoms.”

The researchers concluded that better surveys are needed to gauge these symptoms in children.

“With evolving lifestyles and increasing educational demands, children are potentially at greater risk of developing dry eye disease,” the researchers wrote. “Consequently, there is an urgent need to identify a valid and repeatable instrument for assessing dry eye symptoms in the pediatric population.”