Validation of the Arabic version of the Contact Lens Dry-Eye Questionnaire-۸ in Palestine

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-۸) 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-۸ questionnaire in a clinical context among a sample of Arabic-speaking soft contact lens wearers residing in Palestine. Methods: The CLDEQ-۸ 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 ۱۹ experts by using the Content Validity Ratio (CVR) and the Content Validity Index (CVI). After reviewing the pre-test results, the Arabic-CLDEQ-۸ was finalized. For clinical validation, a web-based version of the Arabic-CLDEQ-۸ 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 ۲۳.۹ (۵.۷) years and with a mean (SD) contact lens-wear time was ۱۰.۵ (۷.۵) hours, including ۳۰ (۸۸.۲%) women, completed the questionnaires. The mean (SD) score on the Arabic-CLDEQ-۸ was ۱۷.۰۰ (۶.۶۹) (range: ۲–۳۰). Cronbach's alpha, indicating internal consistency, was ۰.۹۰۰, and the corrected homogeneity index exceeded ۰.۵۰ for all assessed domains, except for domain ۴ (D۴). The CVI and CVR were ۰.۷۳ and ۰.۸۷, respectively. Domains D۱a, D۱b, D۲a, D۳a, D۳b, and D۴ were found to be clear and simple, while domain D۲b demonstrated an average level of content validity. Conclusions: The trans-cultural adaptation of the CLDEQ-۸ 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-۸ 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