OSDI 干眼调查问卷表

OcularSurfaceDiseaseIndex©(OSDI©)2Askyourpatientsthefollowing12questions,andcirclethenumberintheboxthatbestrepresentseachanswer.Then,fillinboxesA,B,C,D,andEaccordingtotheinstructionsbesideeach.Subtotalscoreforanswers1to5(A)Subtotalscoreforanswers6to9(B)Subtotalscoreforanswers10to12(C)AllMostHalfSomeNoneHaveyouexperiencedanyoftheoftheoftheoftheoftheofthefollowingduringthelastweek?timetimetimetimetime1.Eyesthataresensitivetolight?..432102.Eyesthatfeelgritty?...........432103.Painfulorsoreeyes?..........432104.Blurredvision?...............432105.Poorvision?.................43210HaveproblemswithyoureyesAllMostHalfSomeNonelimitedyouinperforminganyofoftheoftheoftheoftheofthethefollowingduringthelastweek?timetimetimetimetimeN/A6.Reading?....................43210N/A7.Drivingatnight?..............43210N/A8.Workingwithacomputerorbankmachine(ATM)?..........43210N/A9.WatchingTV?................43210N/AHaveyoureyesfeltuncomfortableAllMostHalfSomeNoneinanyofthefollowingsituationsoftheoftheoftheoftheoftheduringthelastweek?timetimetimetimetimeN/A10.Windyconditions?.............43210N/A11.Placesorareaswithlowhumidity(verydry)?...........43210N/A12.Areasthatareairconditioned?...43210N/AAddsubtotalsA,B,andCtoobtainD(D=sumofscoresforallquestionsanswered)(D)Totalnumberofquestionsanswered(donotincludequestionsansweredN/A)(E)Pleaseturnoverthequestionnairetocalculatethepatient’sfinalOSDI©score.EvaluatingtheOSDI©Score1TheOSDI©isassessedonascaleof0to100,withhigherscoresrepresentinggreaterdisability.Theindexdemonstratessensitivityandspecificityindistinguishingbetweennormalsubjectsandpatientswithdryeyedisease.TheOSDI©isavalidandreliableinstrumentformeasuringdryeyedisease(normal,mildtomoderate,andsevere)andeffectonvision-relatedfunction.AssessingYourPatient’sDryEyeDisease1,2UseyouranswersDandEfromside1tocomparethesumofscoresforallquestionsanswered(D)andthenumberofquestionsanswered(E)withthechartbelow.*Findwhereyourpatient’sscorewouldfall.Matchthecorrespondingshadeofredtothekeybelowtodeterminewhetheryourpatient’sscoreindicatesnormal,mild,moderate,orseveredryeyedisease.1211109876543215101520253035404548SumofScoresforAllQuestionsAnswered(DfromSide1)NormalMildModerateSevereNumberofQuestionsAnswered(EfromSide1)10.420.831.341.752.162.572.983.393.8100.011.422.734.145.556.868.279.590.9100.012.525.037.550.062.575.087.5100.013.927.841.755.669.483.397.215.631.346.962.578.193.8100.017.935.753.671.489.3100.020.841.762.583.3100.025.050.075.0100.031.362.593.841.783.362.51.Dataonfile,Allergan,Inc.2.SchiffmanRM,ChristiansonMD,JacobsenG,HirschJD,ReisBL.ReliabilityandvalidityoftheOcularSurfaceDiseaseIndex.ArchOphthalmol.2000;118:615-621Copyright©1995,Allergan*ValuestodeterminedryeyeseveritycalculatedusingtheOSDI©formula.OSDI©=(sumofscores)x25(#ofquestionsanswered)Patient’sName:___________________________________________________________Date:__________________________________Howlonghasthepatientexperienceddryeyedisease?_________________________________________________________________EyeCareProfessional’sComments:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________