The physical and mental burden of dry eye disease: A large population-based study investigating the relationship with health-related quality of life and its determinants

Mathias Kaurstad Morthen,Morten Schjerven Magno,Tor Paaske Utheim,Harold Snieder,Christopher J Hammond,Jelle Vehof

doi:10.1016/j.jtos.2021.05.006

Mathias Kaurstad Morthen, Morten Schjerven Magno + Show 4 more

Open Access

https://doi.org/10.1016/j.jtos.2021.05.006

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Abstract

PurposeThis large cross-sectional population-based study investigated the relationship between dry eye disease (DED) and health-related quality of life (HR-QoL). MethodsDry eye and HR-QoL were assessed in 78,165 participants (19–94 yrs, 59.2% female) from the Dutch population-based Lifelines cohort, using the WHS and the SF36 questionnaire, respectively. Logistic regression was used to assess the relationship between DED and below median Physical Component Summary (PCS) and Mental Component Summary (MCS) score, corrected for age, sex, education, BMI, and 52 comorbidities. ResultsOverall, 8.9% of participants had DED. Participants with DED had an increased risk of low PCS (OR 1.54 (95% CI 1.46–1.62)) and MCS scores (OR 1.39 (95% CI 1.32–1.46)), corrected for age and sex. This risk remained significant after correction for comorbidities (P < 0.0005). Increasing DED symptom frequency was associated with decreasing HR-QoL (P < 0.0005). Undiagnosed DED subjects had a significantly increased risk of low mental HR-QoL with increasing dry eye symptoms compared to diagnosed subjects (P < 0.0005). Compared to allergic conjunctivitis, glaucoma, macular degeneration and retinal detachment, DED showed the highest risk of low HR-QoL. Compared to other common systemic and chronic disorders, such as depression, rheumatoid arthritis, and COPD, DED was distinctive by having a substantial reduction in both PCS and MCS. ConclusionDED is associated with substantial reductions in both physical and mental HR-QoL, also after correction for associated comorbidities. Not having a diagnosis is associated with worse mental HR-QoL in subjects with severe DED. Our results underline the importance of recognizing dry eye as a serious disorder.

Highlights

Dry eye disease (DED) is a multifactorial disease that affects the ocular surface and tear film [1]
We found that subjects with highly symptomatic dry eye have more than twice the risk of having a low mental health-related quality of life (HR-QoL) score (MCS) compared to controls
Our results show that subjects with highly symptomatic dry eye without a prior diagnosis of dry eye by a clinician had worse mental HR-QoL compared to those with a diagnosis of dry eye

Summary

Introduction

Dry eye disease (DED) is a multifactorial disease that affects the ocular surface and tear film [1]. DED is a common condition worldwide, with prevalence estimates ranging from 5 to 50%, depending on the definition used and population studied [1]. Patients report symptoms such as dryness, itching, grittiness, pain, light sensitivity, and blurry vision that can have a severe impact on patients’ lives [1]. Health-related quality of life (HR-QoL) is a multi-dimensional measure that includes domains related to physical, mental, social, and emotional functioning in the context of health and disease [2]. HR-QoL has become an important measure of the impact of disease and to assess treatment efficacy [3], including that of dry eye [4,5]

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