Ocular Surface Disease Index (OSDI): A Full Guide for Researchers and Clinicians.
By ResRef
Published
Learn about the Ocular Surface Disease Index (OSDI): what it measures, how it is scored and interpreted, and how researchers and clinicians use it.
Introduction
The Ocular Surface Disease Index (OSDI) serves as a widely used patient-reported outcome measure for assessing symptom severity and functional limitations in dry eye disease (DED). The Outcomes Research Group at Allergan Inc. (Irvine, California) developed it in 1997, through the work of Rhett M. Schiffman, Murray Dale Christianson, and others, and eventually validated it in 2000. Consequently, clinicians and researchers consider the OSDI a gold-standard tool, as evidenced by its over 3,700 citations. Specifically, the OSDI evaluates both symptom intensity and the real-life impact of ocular surface discomfort on quality of life, functional performance, and treatment outcomes.
This article emphasizes the OSDI’s value as a validated, practical, and scalable instrument. Furthermore, psychometric studies, including Rasch analyses and multilingual cross-cultural adaptations, support its reliability and broad applicability.
Key Features of the Ocular Surface Disease Index (OSDI)
Purpose and Use
The OSDI assesses the severity of dry eye disease symptoms, including ocular irritation and discomfort, while also evaluating how these symptoms impact vision-related functioning.
More specifically, it measures:
Symptom frequency consistent with dry eye diseaseFunctional limitations related to visionEnvironmental factors that worsen ocular surface discomfortAs a result, the OSDI provides a structured, reproducible method for tracking dry eye burden over time.
Target Population
Importantly, the OSDI has validation for adults aged 18 years and older with dry eye or ocular surface disease. This group includes:
Young Adults (18-24 years)Middle-aged adults (25–44)Older Adults (45-64 years)Seniors (+65 years)Structure
The OSDI includes 12 items uniformly divided into three clinically meaningful subscales:
Ocular Symptoms: Includes discomfort indicators such as Light sensitivity, Grittiness, Soreness, and Blurred vision / poor visionVision-Related Function: Evaluates impairment in tasks such as reading, driving at night, computer or ATM use, and watching televisionEnvironmental Triggers: Assesses symptom exacerbation due to Windy environments, Low humidity, and Air conditioningBecause these domains map well to real-world experiences, the OSDI is particularly effective in both outpatient clinics and clinical trial workflows.
Scoring Method
Initially, the OSDI asks patients about their symptom frequency over the past week, utilizing a 5-point Likert scale with responses:
0 = None of the time1 = Some of the time2 = Half of the time3 = Most of the time4 = All the time.Subsequently, these responses are converted into a standardized 0–100 scale using the formula: OSDI = [(sum of scores) × 100] / [(total questions answered) × 4].
Ultimately, this weekly recall period effectively balances sensitivity to short-term changes with reliable patient recall, thus enabling consistent reporting.
OSDI Scores Interpretation
Consequently, total scores range from 0 to 100, whereby higher scores indicate significantly greater disability and symptom severity. Similarly, subscale scores can also be calculated using the same approach. Generally, OSDI scores are commonly categorized for severity as follows:
0–12 = Normal13–22 = Mild dry eye disease23–32 = Moderate dry eye disease33–100 = Severe dry eye diseaseUndeniably, these widely used cutoffs allow researchers to stratify participants effectively, thereby supporting subgroup analyses in clinical trials.
Administration Format
The OSDI is a flexible, self-administered questionnaire that can be delivered in multiple formats, subsequently increasing its usability in real-world clinical and research settings. Specifically, it may be administered in:
Paper-based formatsDigital (Online)In-person interviewsPhone/Video callMost participants complete the OSDI in less than 5 minutes. Therefore, it is particularly attractive for high-volume clinics and longitudinal study designs.
Applications of the Ocular Surface Disease Index (OSDI)
Because it is fast, standardized, and widely validated, the OSDI is frequently used in both clinical and academic ophthalmology for:
Screening: identifying symptomatic dry eye patients in outpatient clinicsMonitoring: Tracking treatment response over timeTreatment Planning: Supporting clinical decision-making and severity stratificationResearch: Serving as an endpoint measure in dry eye trials and epidemiological studies.Importantly, the OSDI is often used in clinical trials evaluating artificial tears, anti-inflammatory therapies, punctal plugs, and environmental interventions.
Languages and availability
Globally, the OSDI has been translated and used across multiple clinical and research contexts worldwide. Furthermore, several versions have undergone formal validation. Validated or published versions include:
EnglishArabicMandarin ChineseSpanish (Chilean)PortugueseJapaneseItalianBahasa Melaya and othersAlthough not all translations have published validation studies, they are still used in clinical and academic contexts.
Generally, the OSDI is considered free for non-commercial use, but it remains under Copyright © 1995, Allergan, and while it is frequently treated as open-access in research contexts, individuals planning commercial use or inclusion in sponsored clinical trials should confirm permission with the appropriate rights holder.
Reliability and Validity
The OSDI is considered a highly reliable and valid instrument, demonstrating excellent internal consistency with a Cronbach’s alpha of 0.92, which indicates strong measurement coherence. Since alpha values above 0.90 typically reflect high reliability, the OSDI is well-suited for use in both clinical screening and research outcome measurement.
Original validation study linkRasch Analysis of the Ocular Surface Disease Index (OSDI) linkArabic Validation Study linkAnother Arabic Validation Study linkSpanish Validation Study linkMandarin Chinese Validation Study linkFarsi Validation Study linkJapanese Validation Study linkItalian Validation Study linkPortuguese Validation Study linkAnother Portuguese Validation Study linkBahasa Validation Study linkLimitations and Considerations
Despite its strengths, the OSDI has a few limitations:
Self-report measure: Respondents may be influenced by social desirability bias or personal interpretationCultural Bias: Some symptom interpretations may vary across languages and healthcare contextsLack of Sensitivity to Change: In some settings, it may not capture subtle symptom variation over short intervalsSocial Desirability Bias: Patients may underreport symptoms due to expectation effectsAdditionally, the OSDI does not assess all dry eye symptoms, such as tearing or foreign body sensation, which may limit completeness in some subtypes.
Other Versions And Related Questionnaires
This questionnaire also has a shorter version:
OSDI-6 (a 6-item abbreviated version)Consequently, this shorter form may be useful when assessment time is limited or when repeated measurement is required at high frequency.
Furthermore, the OSDI is frequently compared or used alongside other ocular surface disease instruments, including:
McMonnies Dry Eye QuestionnaireStandard Patient Evaluation of Eye Dryness Questionnaire (SPEED)Dry Eye Questionnaire (DEQ)McCarty Symptom QuestionnaireNational Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25)Because these tools capture overlapping but distinct constructs, combining them may improve construct validity in complex dry eye phenotypes.
Additional Resources
Original validation study linkOSDI questionnaire PDF access linkOSDI scoring reference (JAMA Ophthalmology) linkRasch analysis of the OSDI linkDry eye questionnaires overview linkAdditional clinical evidence resources link 1, link 2, link 3Contact for questionnaire inquiries: AbbVie Customer Service: customerservice@abbvie.comFrequently Asked Questions (FAQ)
1. Who can use the OSDI?
Clinicians, researchers, and healthcare providers use the OSDI for adults aged 18 and older with dry eye disease or ocular surface symptoms.
2. How long does it take to complete the OSDI?
Patients typically take less than 5 minutes to complete the OSDI, making it highly feasible in clinical and research settings.
3. How is the OSDI administered?
Healthcare teams can administer the questionnaire via paper-based formats, digital platforms, interviews, or phone/video calls, ensuring strong usability across care environments.
4. Is there any cost to using the OSDI?
The OSDI is generally free for non-commercial research and clinical use, although copyright ownership remains attributed to Allergan.
A Word from ResRef about Ocular Surface Disease Index (OSDI)
The Ocular Surface Disease Index (OSDI) is a well-validated, widely used tool that remains a trusted standard for assessing dry eye symptoms due to its brevity, reliability, and clinical usefulness.
References
Bakkar, M. M., El-Sharif, A. K., & Al Qadire, M. (2021). Validation of the Arabic version of the Ocular Surface Disease Index Questionnaire. International journal of ophthalmology, 14(10), 1595–1601. linkZhang, X. M., Yang, L. T., Zhang, Q., Fan, Q. X., Zhang, C., You, Y., Zhang, C. G., Lin, T. Z., Xu, L., Moutari, S., Moore, J. E., Pazo, E. E., & He, W. (2021). Reliability of Chinese web-based ocular surface disease index questionnaire in dry eye patients: a randomized, crossover study. International journal of ophthalmology, 14(6), 834–843. linkTraipe, L., Gauro, F., Goya, M. C., Cartes, C., López, D., Salinas, D., Cabezas, M., Zapata, C., Flores, P., Matus, G., Segovia, C., León, A., & López, R. (2020). Adaptación cultural y validación del cuestionario Ocular Surface Disease Index en una población chilena [Validation of the Ocular Surface Disease Index Questionnaire for Chilean patients]. Revista medica de Chile, 148(2), 187–195. linkSanto, R. M., Ribeiro-Ferreira, F., Alves, M. R., Epstein, J., & Novaes, P. (2015). Enhancing the cross-cultural adaptation and validation process: linguistic and psychometric testing of the Brazilian-Portuguese version of a self-report measure for dry eye. Journal of clinical epidemiology, 68(4), 370–378. linkMidorikawa-Inomata, A., Inomata, T., Nojiri, S., Nakamura, M., Iwagami, M., Fujimoto, K., Okumura, Y., Iwata, N., Eguchi, A., Hasegawa, H., Kinouchi, H., Murakami, A., & Kobayashi, H. (2019). Reliability and validity of the Japanese version of the Ocular Surface Disease Index for dry eye disease. BMJ open, 9(11), e033940. linkFacchin, A., & Boccardo, L. (2024). Psychometric properties and diagnostic performance of three dry eye questionnaires in Italian: OSDI, OSDI-6, and SPEED. Optometry and vision science : official publication of the American Academy of Optometry, 101(9), 579–588. linkRahman, A. A. A., Badarudin, N. E., Azemin, M. Z. C., & Ariffin, A. E. (2017). Development of a Bahasa Melayu Version of Ocular Surface Disease Index (OSDI). International Journal of Allied Health Sciences, 1(1). linkSchiffman, R. M., Christianson, M. D., Jacobsen, G., Hirsch, J. D., & Reis, B. L. (2000). Reliability and validity of the Ocular Surface Disease Index. Archives of ophthalmology (Chicago, Ill. : 1960), 118(5), 615–621. link