Accuracy of McMonnies Questionnaire as a Screening Tool for Chinese Ophthalmic Outpatients

Objective
To evaluate the accuracy of the McMonnies questionnaire (MQ) as a screening tool for dry eye (DE) among Chinese ophthalmic outpatients.
Methods
We recruited 27718 cases from 94 hospitals (research centers), randomly selected from 45 cities in 23 provinces from July to November in 2013. Only symptomatic outpatients were included and they were in a high risk of DE. Outpatients meeting the criteria filled out questionnaires and then underwent clinical examinations by qualified medical practitioners. We mainly evaluated sensitivity, specificity, diagnostic odds ratio (DOR), and area under the receiver-operating characteristic curve (AUC) to evaluate the accuracy of the questionnaire in the diagnosis of dry eye.
Results
Of all the subjects included in the study, sensitivity, specificity, and DOR were 0.77, 0.86 and 20.6, respectively. AUC was 0.865 with a 95% CI (0.861, 0.869). The prevalence of DE among the outpatients claiming “constantly” as the frequency of symptom was over 90%. Scratchiness was a more accurate diagnostic indication than dryness, soreness, grittiness or burning. Different cut points of McMonnies Index (MI) scores can be utilized to optimize the screening results.
Conclusions
MQ can be an effective screening tool for dry eye. We can take full advantage of MI score during the screening process.

## 研究目的
评估麦克蒙尼问卷（McMonnies Questionnaire, MQ）作为中国眼科门诊患者干眼症（dry eye, DE）筛查工具的准确性。

## 研究方法
本研究于2013年7月至11月期间，从覆盖23个省份、45座城市的医疗机构中随机选取94家医院（研究中心），共招募27718例门诊受试者。仅纳入存在干眼相关症状且属于干眼高风险人群的门诊患者。符合入组标准的门诊患者需填写研究问卷，随后由合格执业医师为其完成临床检查。本研究主要通过灵敏度、特异度、诊断比值比（diagnostic odds ratio, DOR）及受试者工作特征曲线下面积（area under the receiver-operating characteristic curve, AUC）四项指标，评估该问卷在干眼症诊断中的准确性。

## 研究结果
本研究纳入的全部受试者中，灵敏度、特异度及诊断比值比分别为0.77、0.86与20.6；受试者工作特征曲线下面积为0.865，95%置信区间（95% CI）为(0.861, 0.869)。自述症状发作频率为"constantly"的门诊患者中，干眼症患病率超过90%。与眼干、眼酸、眼内砂砾感及烧灼感相比，眼痒是更为准确的诊断指征。可通过调整麦克蒙尼指数（McMonnies Index, MI）的不同截断值，优化干眼症筛查结果。

## 研究结论
麦克蒙尼问卷（MQ）可作为有效的干眼症筛查工具，在临床筛查过程中可充分利用麦克蒙尼指数（MI）评分。