UNC Dry Eye Management Scale

HOW TO ADMINISTER THE UNC DRY EYE MANAGEMENT SCALE (UNC DEMS)

Dry Eye Disease (DED)

Dry eye disease (DED) is a common ocular disease that affects 5% to 17% of the United States population with prevalence increasing with age.  Studies have confirmed that DED adversely affects a person’s quality of life (QOL).  

Specifically, DED symptoms can affect a person’s ability to read comfortably, concentrate, operate a computer, drive, or even perform basic work tasks.  Moreover, the adverse effects on QOL typically become more pronounced with disease chronicity and symptom severity.

With the increasing recognition that DED symptoms diminish quality of life, multiple dry eye questionnaires have been developed to evaluate both dry eye symptoms and their effect on quality of life. 

Clinical markers such as fluorescein staining, tear break-up time, and Schirmer testing have high inter-observer bias and lack standardization among eye care providers, correlate poorly with subjective symptoms and provide the rationale for dry eye patient reported outcomes.

Unfortunately, some questionnaires are time-consuming and difficult to score. These questionnaires may also have limitations being implemented in a busy clinical setting.

UNC Dry Eye Management Scale (UNC DEMS)

The University of North Carolina Dry Eye Management Scale (UNC DEMS) is a unique, single-item scale that provides a snapshot of a patient’s overall experience:  symptoms and quality of life over the last week.  It has excellent test-retest reliability and strong validity.1   

Unlike more complicated, time-consuming questionnaires, the UNC DEMS is easily understood and requires little time to administer in the clinic.  Dry eye is a condition requiring both self-management and physician-management. 

The UNC DEMS offers a bridge between patient and provider in working together to manage this challenging disease.  It is our aim that this tool will assist physicians and their patients in the monitoring and management of dry eye disease in clinical practice.1

1.  J Grubbs, Jr. MD, MPH, K Huynh, MD, S Tolleson-Rinehart, PhD, MA Weaver, PhD., J Williamson, MD, C Lefebvre, MD, and RM Davis.  Instrument Development of the UNC Dry Eye Management Scale Cornea; vol.number.month 2014 pp

Purpose

The purpose of the UNC DEMS is to inform providers and patients about dry eye disease status and treatment effectiveness.  The UNC DEMS is a valid and reliable patient reported outcome that characterizes dry eye symptoms such as gritty, dry, foreign body, redness, tearing and irritation sensations. 

As part of the validation process, clinic staff administered The UNC DEMS.  In other words, the UNC DEMS should not be given to patients without instructions by clinic staff.

Administering the UNC DEMS

Administer the UNC DEMS when taking the patient’s history.  Record the patient’s response on a 1-10 Likert scale and write “DEMS = X” in the electronic medical record for the patient reported outcome. 

As you give the UNC DEMS to the patient, ask the patient to read the instructions on the document.  Then say, “ Using these example (point to the boxes), please select the one number on the scale from one to ten that best represents your symptoms and their effect on your daily life over the last week.”

If the patient asks a question, ask the patient to “read the instructions on the UNC DEMS and respond the best way you can.”  If you feel it necessary, repeat the question, “Using these examples (point to the boxes), please select the one number on the scale from one to ten that best represents your symptoms and their effect on your daily life over the last week.”

Timing

The UNC DEMS should be administered at every clinic visit.

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