Tesis

Validitas dan Reliabilitas Kuesioner Dry Eye Indonesia dan Korelasinya dengan Tanda Klinis Objektif pada Pasien = Validity and Reliability of Indonesian Dry Eye Questionnaire and Its Correlations with Objective Clinical Signs in Patients.

Latar belakang: Diagnosis dry eye disease (DED) ditegakkan dengan serangkaian pemeriksaan gejala subjektif dam tanda klinis objektif, namun sayangnya alat penunjang pemeriksaan tidak selalu dimiliki oleh fasilitas layanan kesehatan, sehingga kuesioner yang valid dan reliabel berperan sebagai alternatif untuk menegakkan diagnosis. Kuesioner dry eye Indonesia yang telah dikembangkan untuk populasi Indonesia masih belum tervalidasi dengan jumlah pertanyaan yang belum ideal. Tujuan: Mendapatkan item pertanyaan kuesioner dry eye Indonesia bagian diagnosis yang valid dan reliabel serta mengetahui korelasi klinis antara gejala subjektif dan tanda klinis objektif DED pada pasien. Metode: Penelitian ini terdiri dari tiga tahapan, yaitu (1) focus group discussion (FGD) untuk menilai content validity index (CVI), (2) pretesting untuk menilai cognitive debriefing, validitas, dan reliabilitas pada 30 sampel, dan (3) testing untuk menilai validitas, reliabilitas, dan korelasi klinis dengan tanda klinis objektif pada 60 partisipan. Partisipan melengkapi kuesioner dry eye Indonesia dan ocular surface disease index (OSDI), kemudian dilakukan uji tear break up time (TBUT), tear break up pattern (TBUP), pewarnaan okular, dan Schirmer. Hasil: Jumlah pertanyaan kuesioner dry eye Indonesia dari studi sebelumnya adalah 31 item. Dari hasil FGD dikerucutkan menjadi 14 item pertanyaan, dengan nilai CVI 0,98. Pada tahap pretesting, seluruh item dinyatakan dapat dipahami oleh seluruh subjek dengan nilai validitas dan reliabilitas baik. Dari hasil testing, didapatkan validitas yang dinilai dari corrected item total correlation dan reliabilitas yang dinilai dari Cronbach’s alpha yang baik pada 10 item pertanyaan kuesioner. Sensitivitas dan spesifisitas kuesioner didapatkan 91,1% dan 100% dengan AUC 98,2% (IK95% 94,4%-100%), nilai potong diagnosis DED adalah 10,5. Skor kuesioner dry eye Indonesia didapati berkorelasi positif kuat dengan skor OSDI (r=0,808; p < 0,001) dan berkorelasi negatif lemah (r=- 0,339; p=0,008) dengan TBUT, namun tidak didapati korelasi yang bermakna terhadap Schirmer dan pewarnaan okular. Kesimpulan: Kuesioner dry eye Indonesia bagian diagnosis memiliki validitas, reliabilitas, serta sensitivitas dan spesifisitas yang sangat baik untuk mendiagnosis DED. Korelasi klinis antara skor kuesioner dry eye Indonesia didapatkan bermakna terhadap skor OSDI dan TBUT.
Kata kunci: dry eye disease, sindrom mata kering, kuesioner, dry eye Indonesia


Background: Diagnosis of dry eye disease (DED) is established through a series of examinations of subjective symptoms and objective clinical signs. Unfortunately, diagnostic tools are not always available in healthcare facilities, making valid and reliable questionnaires an alternative for diagnosis. Indonesian dry eye questionnaire developed for the Indonesian population has not yet been validated with an ideal number of questions. Objective: To obtain valid and reliable diagnostic questions for the Indonesian dry eye questionnaire and to determine the clinical correlation between subjective symptoms and objective clinical signs of DED in patients. Methods: This study consists of three stages: (1) focus group discussion (FGD) to assess the content validity index (CVI), (2) pretesting to evaluate cognitive debriefing, validity, and reliability in 30 samples, and (3) testing to assess the validity, reliability, and clinical correlation with objective clinical signs in 60 participants. Participants completed the Indonesian dry eye questionnaire and the Ocular Surface Disease Index (OSDI), followed by testing tear break-up time (TBUT), tear break-up pattern (TBUP), ocular staining, and Schirmer. Results: The number of questions in the Indonesian dry eye questionnaire from the previous study was 31 items, narrowed down to 14 items through FGD with a CVI value of 0.98. In the pretesting stage, all items were found to be understandable by all subjects with good validity and reliability. In the testing phase, 10 questionnaire items showed good validity assessed from corrected item total correlation and reliability assessed from Cronbach’s alpha. The questionnaire demonstrated a sensitivity of 91.1%, specificity of 100%, and an AUC of 98.2% (95% CI 94.4%-100%), with a diagnostic cutoff score for DED at 10.5. The Indonesian dry eye questionnaire score showed a strong positive correlation with OSDI score (r=0.808; p < 0.001) and a weak negative correlation (r=- 0.339; p=0.008) with TBUT, but no significant correlation was found with Schirmer and ocular staining. Conclusion: The diagnostic section of the Indonesian dry eye questionnaire has excellent validity, reliability, sensitivity, and specificity for diagnosing DED. Clinical correlations were found between the questionnaire score and OSDI score and TBUT.
Keywords: dry eye disease, dry eye syndrome, questionnaire, Indonesian dry eye