Tesis

Pengembangan Instrumen Daftar Tilik Deteksi Manifestasi Okular pada Psoriasis Vulgaris, serta Uji Validitas, Reliabilitas, dan Sensitivitas = Development of a Screening Instrument for Detecting Ocular Manifestations in Psoriasis Vulgaris, Including Validity, Reliability, and Sensitivity Tests.

Latar belakang: Manifestasi okular pada psoriasis sering tidak disadari baik oleh dokter maupun pasien. Kelainan mata disebabkan oleh predisposisi genetik, invasi lesi kulit, reaksi autoimun, peradangan sistemik, atau efek samping pengobatan pada psoriasis. Secara global, manifestasi okular berkisar antara 10–80%, dengan kasus berat dapat menyebabkan kerusakan penglihatan permanen. Meskipun demikian, skrining mata belum secara resmi direkomendasikan dalam alur tata laksana psoriasis di Indonesia. Instrumen sederhana, misalnya daftar tilik, penting dalam mendeteksi dini dan merujuk ke dokter spesialis mata (Sp.M) guna mencegah kerusakan okular yang permanen. Penelitian ini bertujuan membuat instrumen daftar tilik yang valid, reliabel, dan sensitif untuk mempermudah skrining kelainan mata pada psoriasis. Metode: Penelitian ini terdiri atas 2 tahap. Tahap pertama penyusunan instrumen daftar tilik berdasarkan gejala subjektif dan objektif kelainan mata pada psoriasis vulgaris, yang diberikan masukan melalui focus group discussion oleh ahli di bidang dermatologi venereologi dan estetika serta mata. Pasien psoriasis vulgaris yang berobat di Poliklinik Dermatologi dan Venereologi RSUPN dr. Cipto Mangunkusumo, diperiksa menggunakan instrumen daftar tilik oleh dokter spesialis Dermatologi Venereologi dan Estetika (Sp.D.V.E). Kemudian seluruh subjek penelitian (SP) dilakukan pemeriksaan mata lengkap oleh dokter Sp.M, untuk mengonfirmasi hasil pemeriksaan sebagai baku emas. Hasil data dianalisis untuk mendapatkan nilai validitas, reliabilitas, dan sensitivitas instrumen daftar tilik. Hasil: Sebanyak 60 SP mengikuti penelitian ini. Instrumen daftar tilik yang dihasilkan memiliki validitas, reliabilitas, dan sensitivitas baik, dengan koefisien korelasi Pearson 0,771 ( > 0,7) nilai p < 0,05, Cronbach α 0,712 untuk pemeriksaan Sp.D.V.E dan 0,721 pada pemeriksaan oleh Sp.M, serta interclass correlation coefficient (ICC) 0,801, serta sensitivitas 94%. Prevalensi kelainan mata yang ditemukan sebesar 84,17% dengan urutan terbanyak yaitu meibomian gland dysfunction (MGD), dry eye, dan katarak. Kelainan mata lainnya berupa glaukoma dan blefaritis juga ditemukan, namun tidak terdapat SP dengan konjungtivitis. Kesimpulan: Instrumen daftar tilik valid, reliabel, dan sensitif dalam mendeteksi dini kelainan mata pada psoriasis.
Kata kunci: instrumen daftar tilik, manifestasi okular, psoriasis vulgaris, skrining


Background: Ocular manifestations in psoriasis often go unnoticed by both doctors and patients. These manifestations may arise from genetic predisposition, skin lesion invasion, autoimmune responses, systemic inflammation, or adverse effects of psoriasis treatment. Globally, ocular manifestations in psoriasis range from 10% to 80%, with severe cases causing permanent vision impairment. Despite these implications, ocular screening is not officially recommended in Indonesian psoriasis treatment guidelines. Simple instruments, such as a checklist, are crucial in early detection and referral to ophthalmologist. This study aims to develop a valid, reliable, and sensitive checklist instrument to facilitate screening for ocular abnormalities in psoriasis. Methods: This study consists of two phases. The first phase involves the development of a checklist instrument based on subjective and objective ocular symptoms in psoriasis vulgaris, with input from focus group discussions with experts in dermatovenereology and ophthalmology. Psoriasis vulgaris patients treated at the Dermatology and Venereology Clinic of the National General Hospital dr. Cipto Mangunkusumo underwent eye examinations using the checklist instrument conducted by dermatovenereologist. Subsequently, ophthalmologists performed comprehensive eye examinations on all participants to confirm results as the gold standard. Data were analyzed for validity, reliability, and sensitivity of the checklist instrument. Results: Sixty subjects participated, with checklist instrument demonstrates good validity, reliability, and sensitivity, with a Pearson correlation coefficient of 0.771 ( > 0.7), p-value < 0.05, Cronbach’s α of 0.712 for examinations by dermatovenereologist and 0.721 for ophthalmologists, as well as an interclass correlation coefficient (ICC) of 0.801, and a sensitivity of 94%. The prevalence of eye disorders found in this study is 84,17%, with the most common eye disorders being meibomian gland dysfunction (MGD), dry eye, and cataracts. Glaucoma and blepharitis were also identified, but no subjects had conjunctivitis. Conclusion: The checklist instrument is valid, reliable, and sensitive in the early detection of ocular manifestation in psoriasis.
Keywords: checklist instrument, ocular manifestation, psoriasis vulgaris, screening