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independent of the other problems associated with SS. The questionnaire is
composed of 49 questions, stratifi ed under seven domains: functional limitation
(Q1–Q9), physical pain (Q10–Q18), psychological discomfort (Q19–Q23), physi-
cal disability (Q24–Q32), psychological disability (Q33–Q38), social disability
(Q39–Q43), and handicap (Q44–Q49). The OHIP-49 questionnaire was shortened
in another study to produce a shortened OHIP-14 version [ 32 ]. Studies carried out
to assess primary SS patients revealed that OHIP is a powerful predictor of self-
rated psychological variables such as depression, self-esteem, and overall life satis-
faction. The results indicate that oral health and function have an independent
infl uence on general quality of life in these patients [ 33 ]. Furthermore, the reduction
in OHIP- 49 scores was comparable to the reduction in SF-36 scores, whereas it was
signifi cantly lower than the control scores [ 7 , 34 ]. Similarly, in another research, the
OHIP-14 total score was signifi cantly correlated with fi ve of the eight SF-36 domain
scores [ 35 , 36 ]. These fi ndings indicate that xerostomia and hypo-salivation have a
considerably negative effect on activities of daily living and social relationships.
This demonstrates how oral disease and poor oral function may have considerable
social and psychological impacts.
Dry Eyes
The Dry Eye Workshop d efi ned dry eye as a “multifactorial disease of the tears and
ocular surface that results in symptoms of discomfort, visual disturbance, and tear
fi lm instability with potential damage to the ocular surface.” [ 37 ] It is accompanied
by detrimental impact on the patients’ HRQOL [ 38 – 42 ]. Earlier published studies
revealed that clinical tests and assessment can be poorly associated with the changes
in symptoms and self-perceived severity of the condition particularly as the disease
progresses [ 37 , 43 – 47 ]. Thus, validated questionnaires that fully assess symptoms
together with the effect of dry eye on daily living have been endorsed [ 48 – 50 ].
Patient-reported outcome measures, used to evaluate the discomfort (specifi c
impact of the eye disease and vision on symptoms), functioning (the ability to carry
out activities in daily living), and perceptions (concern about one’s health), are
referred to as vision-targeted health-related quality of life (VT-HRQ) instruments.
Valid and reliable measurements of VT-HRQ have become mandatory to the assess-
ment of disease status and treatment effectiveness in ocular disease [ 27 ]. There are
two general categories of VT-HRQ instruments : generic, which are designed to be
used for a broad spectrum of visual disorders and ocular disease; and disease-
specifi c, which are tailored toward particular aspects of a specifi c ocular disorder. In
general, disease-specifi c instruments tend to be more sensitive than generic ones in
detecting the VT-HRQ impairments [ 51 ]; however, generic instruments enable
comparisons across more diverse populations and diseases [ 52 – 55 ].
The 25-item National Eye Institute Visual Function Questionnaire (NEI- VFQ- 25)
[ 56 ] is a nondisease-specifi c (i.e., generic) instrument designed to measure the impact
of ocular disorders on VT-HRQ. Depending on the item, responses to the NEI- VFQ
pertain to either frequency or severity of a symptom or functioning problem. A recall
M.O. Hegazi et al.