Validation of the Arabic version of the Contact Lens Dry-Eye Questionnaire-8 in Palestine
Medical hypothesis, discovery & innovation in optometry,
Vol. 5 No. 3 (2024),
25 January 2025
,
Page 93-102
https://doi.org/10.51329/mehdioptometry203
Abstract
Background: The Tear Film and Ocular Surface Society International Workshop on Contact Lens Discomfort has stated that the Contact Lens Dry Eyes Questionnaire (CLDEQ-8) is the only validated clinical tool for assessing dry eye related to the use of soft contact lenses. Although translations of this questionnaire into various languages have been validated, the translation into Arabic has not been validated. We aimed to translate and validate the Arabic version of the CLDEQ-8 questionnaire in a clinical context among a sample of Arabic-speaking soft contact lens wearers residing in Palestine.Methods: The CLDEQ-8 was translated into Arabic via a five-stage process: forward translation, translation revision, backward translation, refinement, and prefinal testing. The content validity of the questionnaire was assessed by a panel of 19 experts by using the Content Validity Ratio (CVR) and the Content Validity Index (CVI). After reviewing the pre-test results, the Arabic-CLDEQ-8 was finalized. For clinical validation, a web-based version of the Arabic-CLDEQ-8 was distributed to eligible soft contact lens wearers in Gaza, Palestine. Internal consistency was evaluated using Cronbach’s alpha and the Corrected Homogeneity Index.
Results: Thirty-four soft contact lens wearers, with a mean (standard deviation [SD]) age of 23.9 (5.7) years and with a mean (SD) contact lens-wear time was 10.5 (7.5) hours, including 30 (88.2%) women, completed the questionnaires. The mean (SD) score on the Arabic-CLDEQ-8 was 17.00 (6.69) (range: 2–30). Cronbach's alpha, indicating internal consistency, was 0.900, and the corrected homogeneity index exceeded 0.50 for all assessed domains, except for domain 4 (D4). The CVI and CVR were 0.73 and 0.87, respectively. Domains D1a, D1b, D2a, D3a, D3b, and D4 were found to be clear and simple, while domain D2b demonstrated an average level of content validity.
Conclusions: The trans-cultural adaptation of the CLDEQ-8 questionnaire led to the development of a reliable and valid tool for assessing the contact lens comfort among Arabic-speaking soft contact lens wearers. This Arabic-CLDEQ-8 was culturally adapted for Arabic-speaking contact lens wearers living in Palestine; thus, future studies should aim to confirm its validity in other Arabic-speaking regions.
Keywords:
- questionnaire
- contact lens
- validity and reliability
- translations
- cronbach’s alpha
- homogeneity index
- content validity ratio
- content validity index

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2. Murphy PJ, Patel S, Marshall J. The effect of long-term, daily contact lens wear on corneal sensitivity. Cornea. 2001 Apr;20(3):264-9. doi: 10.1097/00003226-200104000-00006. PMID: 11322414.
3. Kastelan S, Lukenda A, Salopek-Rabati? J, Pavan J, Gotovac M. Dry eye symptoms and signs in long-term contact lens wearers. Coll Antropol. 2013 Apr;37 Suppl 1:199-203. PMID: 23837244.
4. Sengor T, Aydin Kurna S, Ozbay N, Ertek S, Aki S, Altun A. Contact lens-related dry eye and ocular surface changes with mapping technique in long-term soft silicone hydrogel contact lens wearers. Eur J Ophthalmol. 2012;22 Suppl 7:S17-23. doi: 10.5301/ejo.5000079. PMID: 22101496.
5. Miller WL, Doughty MJ, Narayanan S, Leach NE, Tran A, Gaume AL, Bergmanson JP. A comparison of tear volume (by tear meniscus height and phenol red thread test) and tear fluid osmolality measures in non-lens wearers and in contact lens wearers. Eye Contact Lens. 2004 Jul;30(3):132-7. doi: 10.1097/01.icl.0000138714.96401.2b. PMID: 15499232.
6. Alipour F, Khaheshi S, Soleimanzadeh M, Heidarzadeh S, Heydarzadeh S. Contact Lens-related Complications: A Review. J Ophthalmic Vis Res. 2017 Apr-Jun;12(2):193-204. doi: 10.4103/jovr.jovr_159_16. PMID: 28540012; PMCID: PMC5423374.
7. Markoulli M, Kolanu S. Contact lens wear and dry eyes: challenges and solutions. Clin Optom (Auckl). 2017 Feb 15;9:41-48. doi: 10.2147/OPTO.S111130. PMID: 30214359; PMCID: PMC6095561.
8. Craig JP, Willcox MD, Argüeso P, Maissa C, Stahl U, Tomlinson A, Wang J, Yokoi N, Stapleton F; members of TFOS International Workshop on Contact Lens Discomfort. The TFOS International Workshop on Contact Lens Discomfort: report of the contact lens interactions with the tear film subcommittee. Invest Ophthalmol Vis Sci. 2013 Oct 18;54(11):TFOS123-56. doi: 10.1167/iovs.13-13235. PMID: 24058139.
9. Nichols KK, Nichols JJ, Mitchell GL. The lack of association between signs and symptoms in patients with dry eye disease. Cornea. 2004 Nov;23(8):762-70. doi: 10.1097/01.ico.0000133997.07144.9e. PMID: 15502475.
10. Best N, Drury L, Wolffsohn JS. Predicting success with silicone-hydrogel contact lenses in new wearers. Cont Lens Anterior Eye. 2013 Oct;36(5):232-7. doi: 10.1016/j.clae.2013.02.013. Epub 2013 Mar 20. PMID: 23522993.
11. Pult H, Murphy PJ, Purslow C. A novel method to predict the dry eye symptoms in new contact lens wearers. Optom Vis Sci. 2009 Sep;86(9):E1042-50. doi: 10.1097/OPX.0b013e3181b598cd. PMID: 19668016.
12. Glasson MJ, Stapleton F, Keay L, Sweeney D, Willcox MD. Differences in clinical parameters and tear film of tolerant and intolerant contact lens wearers. Invest Ophthalmol Vis Sci. 2003 Dec;44(12):5116-24. doi: 10.1167/iovs.03-0685. PMID: 14638706.
13. Young G, Chalmers R, Napier L, Kern J, Hunt C, Dumbleton K. Soft contact lens-related dryness with and without clinical signs. Optom Vis Sci. 2012 Aug;89(8):1125-32. doi: 10.1097/OPX.0b013e3182640af8. PMID: 22820475.
14. Foulks G, Chalmers R, Keir N, Woods CA, Simpson T, Lippman R, Gleason W, Schaumberg DA, Willcox MD, Jalbert I; members of the TFOS International Workshop on Contact Lens Discomfort. The TFOS International Workshop on Contact Lens Discomfort: report of the subcommittee on clinical trial design and outcomes. Invest Ophthalmol Vis Sci. 2013 Oct 18;54(11):TFOS157-83. doi: 10.1167/iovs.13-13189. PMID: 24058132.
15. Chalmers RL, Begley CG, Moody K, Hickson-Curran SB. Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) and opinion of contact lens performance. Optom Vis Sci. 2012 Oct;89(10):1435-42. doi: 10.1097/OPX.0b013e318269c90d. PMID: 22960615.
16. Garza-Leon M, Amparo F, Ortíz G, de la Parra-Colin P, Sanchez-Huerta V, Beltran F, Hernandez-Quintela E. Translation and validation of the contact lens dry eye questionnaire-8 (CLDEQ-8) to the Spanish language. Cont Lens Anterior Eye. 2019 Apr;42(2):155-158. doi: 10.1016/j.clae.2018.10.015. Epub 2018 Oct 30. PMID: 30389417.
17. Koh S, Chalmers R, Kabata D, Shintani A, Nishida K. Translation and validation of the 8-item Contact Lens Dry Eye Questionnaire (CLDEQ-8) among Japanese soft contact lens wearers: The J-CLDEQ-8. Cont Lens Anterior Eye. 2019 Oct;42(5):533-539. doi: 10.1016/j.clae.2019.03.002. Epub 2019 Mar 16. PMID: 30890306.
18. Koh S, Chalmers R, Yamasaki K, Kawasaki R, Nishida K. Factors influencing the 8-item contact lens dry eye questionnaire score and comparison of translations in Japanese soft contact lens wearers. Cont Lens Anterior Eye. 2022 Oct;45(5):101519. doi: 10.1016/j.clae.2021.101519. Epub 2021 Oct 5. PMID: 34620551.
19. Dogan AS, Karabulut E, Gurdal C. Validation and reliability of the Turkish version of Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8). Cont Lens Anterior Eye. 2020 Oct;43(5):472-475. doi: 10.1016/j.clae.2020.02.002. Epub 2020 Feb 26. PMID: 32113853.
20. Ribeiro M, Vieira MS, Gorgone G, Barbosa LYC, Martini ARAF, David MA, Fornazari DO, Alves M, Arieta CEL. The contact lens dry eyes questionnaire (CLDEQ-8) validation and ocular surface dysfunction among soft contact lens wearers. Arq Bras Oftalmol. 2022 Jan-Feb;85(1):68-76. doi: 10.5935/0004-2749.20220015. PMID: 34468558.
21. Guo B, Chan KY, Li PH, Tse JSH, Liao X, Eng D, Chen C, Meng Z, Wei R, Cheong A, Ngo W, Lam TC. Validation and repeatability assessment of the Chinese version of the Ocular Surface Disease Index (OSDI), 5-item dry eye (DEQ-5), and contact lens dry eye questionnaire-8 (CLDEQ-8) questionnaires. Cont Lens Anterior Eye. 2024 Dec 17:102353. doi: 10.1016/j.clae.2024.102353. Epub ahead of print. PMID: 39694733.
22. Lortie-Milner É, Boily L, Michaud L, Quesnel NM, Simard P, Milner V, Boissy P. Translation and validation of the contact lens dry eye questionnaire 8 (CLDEQ-8) in Canadian French. Cont Lens Anterior Eye. 2023 Apr;46(2):101779. doi: 10.1016/j.clae.2022.101779. Epub 2022 Dec 6. PMID: 36481132.
23. Mylona I, Aletras V. Validation of the Greek version of the contact lens dry eye questionnaire-8 (CLDEQ-8). Cont Lens Anterior Eye. 2023 Oct;46(5):101890. doi: 10.1016/j.clae.2023.101890. Epub 2023 Jul 5. PMID: 37419783.
24. Zeri F, Tavazzi S, Naroo SA, Recchioni A, Menduni F, Ponzini E, Chalmers R, Desiato A. Italian translation and validation of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8). Cont Lens Anterior Eye. 2023 Jun;46(3):101842. doi: 10.1016/j.clae.2023.101842. Epub 2023 Apr 4. PMID: 37024414.
25. Alamri A, Amer KA, Aldosari AA, Al-Muhsin SD, Al-Maalwi RS, Al Hamdan SA, Al-Tarish LM. Assessment of Dry Eye Syndrome Among Contact Lens Users in Asir Region, Saudi Arabia. Cureus. 2022 Jan 23;14(1):e21526. doi: 10.7759/cureus.21526. PMID: 35223301; PMCID: PMC8863558.
26. Almutairi AH, Alalawi BS, Badr GH, Alawaz RA, Albarry M, Elbadawy HM. Prevalence of dry eye syndrome in association with the use of contact lenses in Saudi Arabia. BMC Ophthalmol. 2021 Mar 23;21(1):147. doi: 10.1186/s12886-021-01912-8. PMID: 33757466; PMCID: PMC7986502.
27. Abusageah F, Alhazmi E, Otayf B, Zogel T, Alharbi W, Hakami F, Abulqusim E, Manni R, Moafa H, Dighriri IM, Alagsam A. The Assessment of Dry Eye Syndrome in Relation to the Use of Contact Lenses in the Jazan Region of Saudi Arabia: A Cross-Sectional Study. Cureus. 2024 Oct 24;16(10):e72247. doi: 10.7759/cureus.72247. PMID: 39583475; PMCID: PMC11584416.
28. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000 Dec 15;25(24):3186-91. doi: 10.1097/00007632-200012150-00014. PMID: 11124735.
29. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007 Aug;30(4):459-67. doi: 10.1002/nur.20199. PMID: 17654487.
30. Romero Jeldres M, Díaz Costa E, Faouzi Nadim T. A review of Lawshe’s method for calculating content validity in the social sciences. In Frontiers in Education 2023 Nov 20 (Vol. 8, p. 1271335). Frontiers Media SA. doi: 10.3389/feduc.2023.1271335.
31. Yusoff MS. ABC of content validation and content validity index calculation. Education in medicine journal. 2019 Jun 28;11(2):49-54. doi: 10.21315/eimj2019.11.2.6.
32. Morgan PB, Efron N, Hill EA, Raynor MK, Whiting MA, Tullo AB. Incidence of keratitis of varying severity among contact lens wearers. Br J Ophthalmol. 2005 Apr;89(4):430-6. doi: 10.1136/bjo.2004.052688. PMID: 15774919; PMCID: PMC1772596.
33. Stapleton F, Keay L, Edwards K, Naduvilath T, Dart JK, Brian G, Holden BA. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008 Oct;115(10):1655-62. doi: 10.1016/j.ophtha.2008.04.002. Epub 2008 Jun 5. PMID: 18538404.
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