Transcultural Validation of the Five-Item Dry Eye Questionnaire for Indonesian Populations

Purpose Indonesian dry eye (DE) disease (DED) prevalence data remain scarce, and Indonesian validations of the five-item Dry Eye Questionnaire (DEQ-5) are unavailable. We aimed to translate and validate an Indonesian language adaptation of the DEQ-5 (INDO-DEQ-5) for local populations. Methods Our observational study involved linguistic validation of the translation, reliability testing, dataset screening, and data collection through ophthalmic examinations and interviews. Outpatient adults with dry eye symptoms and formal DED diagnoses were included. Data were captured at patients' enrolment, at their self-administered INDO-DEQ-5, and at ophthalmic examinations. This data was statistically analyzed for agreement, test-retest reliability, and by a receiver operator characteristic (ROC) curve for dry eye sensitivity and specificity. Results Tear breakup time (TBUT) was the most frequently used clinical diagnostic parameter, with 96.8% of DED patients having abnormal TBUT. We captured 87.23% of all true DE cases, while the ROC and area under the ROC curve analyses found similar sensitivity between the INDO-DEQ-5 and the composite clinical diagnosis of DE, and TBUT was equivalent to the INDO-DEQ-5 in clinical diagnoses. The level of reliability of the INDO-DEQ-5 was moderate, and subscales were moderate or substantial. Conclusion The prediction of DE with TBUT was similar to predictions using the composite definition of clinical DE diagnosis, while the INDO-DEQ-5 diagnostic accuracy was similar to that of TBUT or a composite clinical diagnosis. Thus, the INDO-DEQ-5 is a reliable tool for the clinical evaluation and diagnosis of DE in Indonesian populations and will enable clinicians to rapidly collect accurate data to improve therapeutic management.