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DIAGNOSTIC VALUE OF THE OSDI QUESTIONNAIRE IN DETECTING
NEUROPATHIC EYE PAIN IN PATIENTS AFTER LASIK
Zakirkhodjaev R.A.
DSc, associate professor of the department of ophthalmology, Tashkent State
Medical University, Tashkent, Uzbekistan
Azimova G.A.
Expert ophthalmologist of the military medical commission of the medical
department of the Tashkent city Main Department of Internal Affairs, Tashkent,
Uzbekistan
https://doi.org/10.5281/zenodo.15847578
Background.
The Ocular Surface Disease Index (OSDI) questionnaire is
widely used to quantify dry eye syndrome (DES) symptoms. However, its
potential in differentiating classic DES from neuropathic ocular pain (NOP) after
LASIK remains incompletely understood. Given the growing number of patients
complaining of pain with minimal objective signs of ocular surface damage,
validation of the questionnaire as a screening tool is of practical importance.
Objective.
To evaluate the diagnostic ability of the OSDI in identifying
neuropathic ocular pain in patients with chronic dry eye syndrome after LASIK
surgery.
Materials and methods.
From September 2024 to May 2025, a prospective
clinical study was conducted at the Ziyobakhsh private multidisciplinary clinic
aimed at assessing the diagnostic value of the OSDI questionnaire in identifying
neuropathic ocular pain in patients after keratorefractive surgery. The study
included 35 people (70 eyes), divided into three groups: 10 patients with a high
degree of myopia (≥6.0 D) and symptoms of dry eye syndrome without severe
pain; 10 patients with myopia of a similar degree, a combination of symptoms of
dryness and neuropathic eye pain; the control group consisted of 15 practically
healthy volunteers without ophthalmological complaints and a history of
surgical interventions. The average age of the examined subjects was 29.3±5.2
years, 57.1% were women, 42.9% were men. All participants underwent a
standard ophthalmological examination, as well as a questionnaire using a
validated Russian-language version of the Ocular Surface Disease Index (OSDI)
questionnaire.
Study results.
The total scores of the OSDI questionnaire significantly
differed between the three clinical groups (p<0.01). In practically healthy
volunteers, the average value was 9.1±3.4 points, in patients with dry eye
syndrome without pain syndrome 42.5±6.3 points, while in patients with a
combination of dry eye syndrome and neuropathic pain 46.8±5.7 points. The
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threshold value on the OSDI scale of 45 points made it possible to assume the
presence of neuropathic eye pain with a high accuracy, providing a sensitivity of
80% and a specificity of 87%. Calculations showed that the probability of
accuracy of these indicators is within the confidence interval from 82% to 99%.
The test with a topical anesthetic was positive in eight out of ten patients of the
second group, which indicates the presence of central sensitization. A reliable
positive correlation was also established between the severity of subjective
complaints on the OSDI scale and the stability of the pain syndrome after local
anesthesia (correlation coefficient r=0.62; p<0.01). The obtained data confirm
that the combination of a high OSDI score and a positive anesthetic test can
serve as a reliable clinical marker of neuropathic eye pain in the post-refractive
period.
Conclusions.
The OSDI questionnaire demonstrates high diagnostic
accuracy in screening for neuropathic eye pain in post-LASIK patients. A
threshold of ≥45 points together with a positive central sensitization test allows
for reliable differentiation of NGP from classic dry eye syndrome and guides the
physician to conduct an in-depth examination (confocal microscopy, assessment
of psychoemotional status). Thus, OSDI can serve as the first stage of the
algorithm for early detection of NGP in routine ophthalmological practice.
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