Evaluating the OSDI Score'

The OSDI° is assessed on a scale of 0 to 100, with higher scores representing greater disability.
The index demonstrates sensitivityand specificity in distinguishing between normal subjects
and patients with dry eye disease. The OSDI is a valid and reliable instrument for measuring
dry eye disease (normal, mild to moderate, and severe) and effect on vision-related function.
Assessing Your Patient's Dry Eye Disease:
Use your answers D and E from side 1 to compare the sum of scores for all questions
answered (D)and the number of questions answered (E) with the chart below.* Find where
your patient'sscore would fall. Match the corresponding shadeof red to the key below to
determine whether your patient's score indicates normal, mild, moderate, or severe dry eye
disease.

Answered 12 10.4 20.8 31.3 41.7 52.1 62.5 72.9 83.3 93.8 100.0
11 11.4 22.7 34.1 45.5 56.8 68.2 79.5 90.9 100.0
1) 10 12.5 25.0 37.5 50.0 62.5 75.0 87.5 100.0
Side
Questions 9 13.9 27.8 41.7 55.6 69.4 83.3 97.2
from 8 15.6 31.3 46.9 62.5 78.1 93.8 100.0
7 17.9 35.7 53.6 71.4 89.3 100.0
of (E 6 20.8 41.7 62.5 83.3 100.0
Number
5 25.0 50.0 75.0 100.0
4 31.3 62.5 93.8
3 41.7 83.3 "Values to detenine dry eye severity calaulated using the OSDP fomula
2 62.5 OSDI= (sumof sCores) x25
(#of questions answered)
1

5 10 15 20 25 30 35 40 45 48
Sumof Scores for Al
QuestionsAnswered (D
from Side 1)

Normal Mild Moderate

Severe

Date:
Patient's Name:
How long has the

patient experienced dry eye disease?

Eye Care Professiona>s

Commets:

1. Data on file, Allergan, Inc.

Reliability and validity of the
2. Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Copyright O
Ophthalmol. 2000;118:615-621
Ocular Surface Disease Index. Arch
1995,Allergan

35
ANNEXURE 2: 0CULAR SURFACE DISEASE INDEX-QUESTIONNAIRE
Have you experienced any of the All Mos Half Som Non
following during thelastweek? of t of of e of e of
the the the the the
time time time time time
1. Eyes that are sensitiveto light?. 4 0

2. Eyes that feel gritty?

3. Painful or sore eyes? 3 2
4. Blurred vision? 4 3 2 0

5. Poor vision? 4 3 2 1 0

Subtotal score for answers 1 to5

Have problems with your eyes AlI Mos Half Som Non
limited youin performing any of of
the following durng the last week? the
t
the
of of
the
-
e of
the
e of
the N/A
time time time time time
6. Reading?. 3 N/A
1 N/A
7. Drivingat night? . 4 3
8. Working with acomputer or 4 3 2
bank machine (ATM)?. N/A
9. Watching TV? 3 2 1 0 N/A

Subtotal score foranswers 6 to9

Have your eyes fet uncomfortable All Mos Half Som Non
in any of the following situations of t of of e of e of
duringthe last week? the the the the the N/A
time time time time time
4 3 2 1 N/A
10. Windy conditions?.
11. Places or areas with low 4 3 2 1
N/A
humidity (very dry)?
12. Areas that are air conditioned?... 4 3 2 1 N/A

Subtotal score for answers 10 to 12 (O)

Addsubtotals A, B, and Cto obtain D

(D=sumof scores for allquestions answered) (D)

34
43
 Patient Consent Form

Title of the Stud:

Study Numer:
FullName of Participant( vith Father's Name):
Date of Birth/Age:
Address:
Occupation: Student/Self- Employed/Service/ Homemaker/Other:
(Please indicate appropriately )
Name and Address of the Designated Representatitve and their relationship with the
individual:

| lconfirm that Ihave recad and understood the information shcct dated for the above
study and have had the opportunity to ask questions.
at any
2 iunderstand that my participation in the study is voluntary andthat i am free to withdraw
time. without giving any reason and without my medical care or legal rights being affected.

on the Sponsor's behalf.

3 Iunderstand that the sponsor of the clinical trial/project, others workingpermission to look at my
the Ethics Committee and the regulatory authorities will not need my
that may be conducted
health records both in respect of the current study and any further research
that my Identity will not
in relation to it, even if Iwithdraw from the trial. However, I understand
be revealed in any information released to thirdparties or published.
from this study provided such a use is
4 Iagree not to restrict the use of any data or results that arise
only for scientific purpose(s)

5 lagree to take part in the above study

Subject/Legally Acceptable Representative:

Signature (or Thumb impression) of the

Signatory's Name:
Date:
Relationship with subject:

Investigator's statement:
she/he understands the
undersigned have explained to the parent/guardian in a language
I. the the risks and benefits.
procedures to be followed in the study and

Representative's Signature( or Thumbprint)

Signature of Participant/ Legally Acceptable
Date:
Signature of theInvestigator:
Name of the lnvestigator:
Date:
Signature of the Witness:
Name of the Witness

42
 Ocular examination: OD OS
Visual acuity(BCVA)
Anterior segment
Conjunctiva
Cornea
Size

Shape
Surface

Transparency
Corneal sensations
Schirmer's test-I
Tear film Break up time(TBUT)
Conjunctival and corneal staining: Rose Bengal stain
Fundus :

Anterior segment 0CT:

Meibomian gland dysfunction:
Keratometry:

Lab investigations:
Rheumatoid factor (RA):
Complete blood count (CBC):
Erythrocyte sedimentation rate (ESR):
C-Reactive protein(CRP):

Results (to be recorded)

32
 Case Proforma

CR No: Name: Age/Sex:

Address: Occupation: Literacy status:
Monthly Income: Phone no: Date:

Chief complaints:

History of Presenting IlIness:

Past History:

Personal History:

Family History:

Treatment History:

General Physical examination:

Pulse rate: Blood pressure: Respiratory rate: Temperature:

Musculoskeletal examination(DAS28 Score):

31
Annexure 1: DISEASE ACTIVITY SCORE( DAS-28)

FORM A RIGHT LEFT

SWOLLEN TENDER SWOLLEN
Shoulder TENDER
Elbow
Wrist
Metacarpophalangeal (MCP)
2
3
4

Proximal interphalangeal 1
2
(PIP)
3
4

Knee
Subtotal
SWOLLEN TENDER
TOTAL

FORM B
Swollen(0-28)
Tender( 0-28)
ESR(or CRP)
VAS disease activity (0-100mm)
DAS 28= 0.56* V(TENDER JOINTS) + 0.28* V
(SWOLLEN JOINTS) + 0.70* LN( ESR/CRP) +
0.014*VAS
SCORE:
HOW TO CALCULATE DAS 28
patiernt, noting each affected joint on Fom A. When
1. Perfom aswollen and tender joint exarnination ofyour
the appropriate boxes on Fom B.
complete, add all of theswollen and tender joirts and record the totals in
(ESR) in mmh in the appropriate box on Fomm B.
2. Obain and record the patiernt's erythrocyte sedimentation rate
substitute for an ESR.
Note: C-reacive protein (CRP)evels may be used as a
Analog Scale (VAS) of 100 mm in theappropriate box
3. Obtain and record the patient's general health on a Visual
without a VAS measuremert.
on Fom B. Note: DAS28 calculations may be perfoned
ofFom B(mary online calculators ae available to
4. Plug the appropriate values into the fomula at the bottom
htp:/www.das-score.n/www.dassCore.n/dasculators.htm).
Compute this value including
A DAS28 score of higher tharn 5.1 is indicative of high
disease activity, whereas a DAS28 below
remission ifthey have a DAS28 lower than 2.
3.2 indicates low disease activity. A patient is considered to be in

33