Reviewer ’s report  
 
Title: Vision -Related Quality of Life and Psychologic al Status in Chinese Women with 
Sjogren's  Syndrome Dry Eye: A Case -Control Study  
 
Version: 1 Date: 21 Mar 2016  
 
Reviewer: Jill Carlton  
 
Reviewer's report:  
 
This is an interesting study that contributes to the existing body of work examining the impact of 
ocular conditions upon vision -related quality of life.  The authors acknowledge the low numbers 
within the study itself, and advocate further research to confirm the findings described.  
 
 
 
The administration of the self -reported instruments could b e considered further in the 
manuscript, particularly in the discussion.  The authors state that the questionnaires were issued 
after ocular examination.  What impact does the examinations have themselves upon the 
patient??  Do the tests involved in determi ning the clinical severity of SS exacerbate a patient's 
symptoms?  Is it possible that the tests themselves may influence how a patient feels on that day?   
 
 
 
Furthermore, additional detail and comment should be included on the order of the 
questionnaires ( were the same questionnaires given in the same order for every patient?  Order 
effects?); and the task burden associated with so many questionnaires.  In total each participant 
was given over 70 questions to answer on their own health.  How reliable is tha t data given that 
the participant has already undergone extensive ocular examination too.  There should be some 
comment and discussion about this.   
 
 
 
The phrasing and time scale of the questionnaires should may need to be looked at again.  In 
what context do the questionnaires assess qualitity of life?  OSDI asks about "the last week", 
NEIVFQ25 asks about that day, and I am unsure of the anxiety and depression scales used.  
Perhaps there should be some discussion around the framing of the questions, and tha t the results 
of this particular study provide a snapshot of what QoL.   
 
 
 
Finally, further detail (perhaps in supplementary material/appendix) should be given on the data 
obtained from the questionnaires.  Whilst the mean and SD are provided, the reader wo uld 
benefit from knowing the distribution for the two groups for each instrument.  It is evident that 
that NEIVFQ25 is not as sensitive at detecting difference between the SSDE and non -SSDE 
group - do the authors advocate one instrument in preference to an other?  What are the effect 
sizes between the difference in means between the two groups for each scale/domain?  That 
would provide more information to the reader, which may be more informative than the p value 
(in that such small numbers were involved in the study).  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
 
 
 
 
 
 
 
 
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the fol lowing questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
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3. Do you hold or are you currently applying for any patents relating to the content of the  
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4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
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