Open Access Opinion

Dry Eye Disease: The Undervalued Impact on Quality of Life

Nina Asrini Noor*

Dry Eye Service, JEC Eye Hospitals and Clinics, Indonesia

Corresponding Author

Received Date: August 10, 2018;  Published Date: November 15, 2018

Abstract

Dry eye disease (DED) is one of most common ocular disease and reason for primary eye care visit worldwide. Besides ocular discomfort, visual disturbance is also a common symptom reported by patients with this disease. The symptoms may vary from mild to severe degree which can affect daily activities and quality of life. Studies have shown that DED interfered with reading and driving ability and associated with increased anxiety, stress and depression. Thus, DED should be considered as an important public health problem deserving increased attention. Unfortunately, the attention towards DED amongst eye professionals is still somewhat low in general. It has become a necessity to increase awareness and continue to carry out studies that will expand our understanding, support the innovation of new treatment, and improve patient’s quality of life. Simply throwing artificial tears to the patients expecting that it would immediately ease their symptoms is no longer acceptable. Patients with DED should be assessed comprehensively and treated as a whole, not merely “eyes that are not wet enough”.

Keywords:Dry eye disease; Quality of life; Quality of vision; Visual disturbance

Introduction

Dry eye disease (DED) is one of most common ocular disease and reason for primary eye care visit worldwide. DED has gone through major evolutions over the past couple of decades. As stated in the latest DEWS II report in 2017, the definition of DED is now “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles” [1].

Prevalence of DED based on symptoms ranged from 14.5% to 39.2% in various countries [2-5]. This may still be an underestimated number as there are many who have symptoms but do not seek medical care. However, the reason behind the general increase in dry eye remains a question as it is not completely known if there is a true increase in prevalence or improved sensitivity to diagnosis.

Lifestyle changes which include increasing screen time activities, diets poor in omega-3 fatty acids, and increased number of refractive treatments (contact lens wear, laser vision correction and cataract surgery) may play a role [6]. Moreover, recognition of autoimmune diseases which are associated with DED such as Sjogren disease, rheumatoid arthritis, and thyroid disease may lead to improved diagnosis and management.

Dry eye complaints are frequently encountered by all ophthalmologists. Symptoms and signs of DED can be one of the most common causes of patient dissatisfaction during medical visits.6 Generally, patients with DED may experience ocular discomfort including pain, burning sensation, foreign body sensation, grittiness, and tearing. Others may complain of dryness, ocular fatigue, and sometimes redness [7,8].

Visual disturbance is also a common symptom reported by patients with this disease. People with DED often report visual disruption such as glare, fluctuating and foggy vision; often despite normal visual acuity. Reduction in visual function can be measured by several methods including questionnaires, contrast sensitivity tests, functional visual acuity (FVA) tests, and measurement of higher-order optical aberrations (HOA) [9]. The symptoms of visual disturbance may vary from mild to severe degree which can affect daily activities including physical, social, psychological functioning, and workplace productivity [9-12].

Consequently, DED has become a growing public health concern that interferes with many different aspects of quality of life. DED is associated with adverse impact on several common and important tasks of daily living, emotional well-being, and the ability to work [13,14]. The impairment of vision-related quality of life has significant correlation with the severity of the disease [15]. Numerous studies have been performed to better understand the effect of DED towards quality of life. One example of how DED affects daily living is that it interferes with reading ability. Ridder et al demonstrated that reading rate was lower in subjects with DED. As severity of the disease increased, the reading rate decreased. This finding is consistent with patient-reported symptoms and provides direct evidence for the impact of DED on reading performance [16].

Degradation of optical qualities related to DED is also associated with visual impairments during driving. The average response time was significantly increased in patients with DED. Their visual function was even more impaired in specific situations, such as crossroad or roundabout approaches [17]. Furthermore, reports have demonstrated that DED is also related to depression. Patients with DED had impaired vision-related quality of life and this impairment was correlated with anxiety and depression [18,19]. Another study in women with dry eye symptoms demonstrated a close association between depression, stress, and DED [20]. The impact of tear film-related visual disturbance on activities of daily living and mental health in patients with DED has been objectively demonstrated in all the aforementioned studies. Hereafter, DED should be considered as an important public health problem deserving increased attention.

Unfortunately, the attention towards DED still seems to be low in general. A study by Graham et al indicated that the interest in the issue of dry eye is very much limited among ophthalmologists and optometrists [21]. Their study demonstrated poor participation in the questionnaire used to survey attitudes towards diagnostic tests and treatments of DED. It is highly likely that major eye professionals in general would give similar responses. DED is often considered as a “difficult” disease due to its dynamic and multifactorial nature. Treatments sometimes require not only medications, but also understanding the symptoms and counseling on how it affects patient’s quality of life. The complexity of DED makes it gather little attention compared to other diseases which are “simpler” to treat.

Therefore, it is necessary to increase our awareness of DED and improve our practice in dealing with dry eye patients. It is also indispensable to continue studies which will help our understanding of this disease and support the innovation of new treatment. Incorporating vision-related quality of life into the study would provide further explanation, for example the effect of treatments towards quality of vision. Given the available knowledge on how DED interferes with patient’s vision-related quality of life, it is no longer acceptable to simply throw the next brand of artificial tears to the patients hoping that it would immediately ease their symptoms. Ophthalmologists are urged to assess DED comprehensively and treat the patients as a whole, from symptoms and signs on their eyes to activities of daily living and vision-related quality of life, not merely “eyes that are not wet enough”.

Acknowledgement

None.

Conflict of interest

No conflict of interest.>

References

  1. https://www.ncbi.nlm.nih.gov/pubmed/19191177
  2. Malet F, Le Goff M, Colin J, Schweitzer C, Delyfer MN, et al. (2014) Dry eye disease in French elderly subjects: the Alienor Study. Acta Ophthalmol 92(6): 429-436.
  3. Malet F, Le Goff M, Colin J, Schweitzer C, Delyfer MN, et al. (2014) Dry eye disease in French elderly subjects: the Alienor Study. Acta Ophthalmol 92(6): 429-436.
  4. Paulsen AJ, Cruickshanks KJ, Fischer ME, Huang GH, Klein BE (2014) Dry eye in the beaver dam offspring study: prevalence, risk factors, and health-related quality of life. Am J Ophthalmol 157(4): 799-806.
  5. Vehar J, Kozyrev D, Haysi PG, Hammond CJ (2014) Prevalence and risk factors of dry eye disease in a British female cohort. Br J Ophthalmol 98(12): 1712-1727.
  6. Farid M (2017) Dry Eye Disease: Let’s Start Thinking Outside of the Artificial Tear Box. Ophthalmology 124(11): S1-S3.
  7. Uchino M, Schaumberg DA, Dogru M, Uchino Y, Fukagawa K, et al. (2008) Prevalence of dry eye disease among Japanese visual display terminal users. Ophthalmology 115(11): 1982-1988.
  8. Terry MA (2001) Dry eye in the elderly. Drugs Aging 18(2): 101-107.
  9. Uchino M, Schaumberg DA (2013) Dry Eye Disease: Impact on Quality of Life and Vision. Curr Ophthalmol Rep 1(2): 51-57.
  10. Moss SE, Klein R, Klein BE (2008) Long-term incidence of dry eye in an older population. Optom Vis Sci 85(8): 668-674.
  11. Tong L, Waduthantri S, Wong TY, Saw SM, Wang JJ, et al. (2010) Impact of symptomatic dry eye on vision related daily activities: the Singapore Malay Eye Study. Eye (Lond) 24(9): 1486-1491.
  12. Lee AJ, Lee J, Saw SM, Gazzard G, Koh D (2002) Prevalence and risk factors associated with dry eye symptoms: a population-based study in Indonesia. Br J Ophthalmol 86(12): 1347-1351.
  13. Pouyeh B, Viteri E, Feuer W, Lee DJ, Florez H (2012) Impact of ocular surface symptoms on quality of life in a United States veterans’ affairs population. Am J Ophthalmol 153(6): 1061-1066.
  14. Miljanovic B, Dana R, Sullivan DA, Schaumberg DA (2007) Impact of dry eye syndrome on vision-related quality of life. Am J Ophthalmol 143(3): 409-415.
  15. Le Q, Ge L, Li M, Wu L, Xu J, et al. (2014) Comparison on the vision-related quality of life between outpatients and general population with dry eye syndrome. Acta Ophthalmol 92(2): 124-132.
  16. Ridder WH, Zhang Y, Huang JF (2013) Evaluation of reading speed and contrast sensitivity in dry eye disease. Optom Vis Sci 90(1): 37-44.
  17. Deschamps N, Ricaud X, Rabut G, Labbe A, Baudouin C, et al. (2013) The impact of dry eye disease on visual performance while driving. Am J Ophthalmol 156(1): 184-189.
  18. Li M, Gong L, Chapin WJ, Zhu M (2012) Assessment of vision-related quality of life in dry eye patients. Invest Ophthalmol Vis Sci 53(9): 5722- 5727.
  19. Liyue H, Chiang PP, Sung SC, Tong L (2016) Dry Eye-Related Visual Blurring and Irritative Symptoms and Their Association with Depression and Anxiety in Eye Clinic Patients. Curr Eye Res 41(5): 590-599.
  20. Na KS, Han K, Park YG, Na C, Joo CK (2015) Depression, Stress, Quality of Life, and Dry Eye Disease in Korean Women: A Population-Based Study. Cornea 34(7): 733-738.
  21. Graham JE, McGilligan VE, Berrar D, Leccisotti A, Moore JE, et al. (2010) Attitudes towards diagnostic tests and therapies for dry eye disease. Ophthalmic Res 43(1): 11-17.
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