TEARS Grading scale: grading the clinical severity of epiphora
Research type
Research Study
Full title
Development and validation of the TEARS grading scale: a clinical tool for grading the severity of epiphora
IRAS ID
245264
Contact name
Raman Malhotra
Contact email
Sponsor organisation
Queen Victoria Hospital
Duration of Study in the UK
1 years, 2 months, 1 days
Research summary
Research Summary
Epiphora (watery eye) is a common presentation to the ophthalmology clinic, with most patients being amenable to surgical (61-69%) or non-surgical treatment. Surgically-amenable epiphora affects an estimated 16/100 000 persons rising to 100/100 000 in 75-84 year olds. While in some, the epiphora represents no more than a tolerable nuisance, in others it significantly affects their quality of life. At the more severe end of the spectrum, some cases require repeat medical attendances and hospital admissions for systemic infection. With ever-increasing financial constraints on healthcare providers, there is a need for clinicians and healthcare commissioners to better prioritise patients for surgical intervention.
The ‘TEARS scale’ was developed through extensive literature review, patient focus groups and consultation with an expert panel of consultant ophthalmologists. Disease severity is graded based on 4 subscales: symptom frequency, the effects on patients and healthcare providers, patients’ functional status, and the compounding effect of ocular surface disease.
This prospective study aims to validate the TEARS scale by recruiting adult patients presenting to oculoplastic clinics with epiphora. Two independent assessors will complete the TEARS grading scale at the study entry point. Patients will complete two questionnaires: The Watery Eye Quality of Life score (WEQOL) and The Lacrimal Symptom Questionnaire (Lac-Q).
In a subset of patients who have agreed with their clinician to undergo either surgical or non-surgical intervention, the TEARS scale will again be completed at their clinical review by two clinicians between 3 and 6 months after their initial visit. Patients will again complete the WEQOL and Lac-Q, as well as the Glasgow Benefit Inventory (a measure of change in quality of life).
The scale’s construct validity will be assessed by evaluating the change in subscale scores following clinical intervention and their correlation with other patient-reported outcome measures. The inter-observer reliability of the TEARS score will be evaluated.
Summary of Results
The TEARS score was developed and tested as a measure of clinical disease severity in patients with watery eye. It was found to have moderate reliability when used by different clinicians on the same individual patient. It was found to represent patient quality of life moderately well when tested against other validated questionnaires. The TEARS score is quickly and easily implemented in a busy clinical setting. It is able to demonstrate improvements in disease severity post-operatively.
REC name
North West - Greater Manchester West Research Ethics Committee
REC reference
18/NW/0769
Date of REC Opinion
7 Nov 2018
REC opinion
Favourable Opinion