Diagnostic Performance of McMonnies Questionnaire as a Screening Survey for Dry Eye: A Multicenter Analysis

Purpose. To evaluate the diagnostic performance of the McMonnies questionnaire as a screening survey for dry eye in Chinese outpatients. Methods. The questionnaire was self-administered by 27,999 patients with dry eye symptoms. A thorough ophthalmic examination including tear break-up time (TBUT), fluorescein staining, and Schirmer I test was completed to make a clinical diagnosis of dry eye. Reliability, validity, and accuracy of the McMonnies questionnaire were assessed. Results. The McMonnies questionnaire showed poor internal consistency (Cronbach ), but excellent validity as the scores correlated with TBUT (Spearman test, , ) and Schirmer I test (Spearman’s test, , ), and significantly differed between the dry eye and control groups (2-sample t-test, , ). The area under the receiver-operating characteristics (ROC) curve (AUC) was 0.729, suggesting moderate accuracy in identifying dry eye and non-dry eye patients. However, the AUCs varied significantly in different gender and age subgroups (z test, ), as the discriminating ability declined with age. Analysis of the ROC curves also revealed that different cut-off points should be employed for each subgroup to achieve the same level of accuracy. Conclusions. The McMonnies questionnaire demonstrates moderate diagnostic value, and different cut-off points should be selected for various study populations.

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