dry eye dx and tx

The Impact of Dry Eye on Quality of Life

BY WILLIAM TOWNSEND, OD, FAAO

I work in a setting that allows me to spend a great deal of time with patients who suffer from dry eye disease. Three things that continually amaze me are the number of patients we see who have this condition; the apparent lack of effort on the part of many eyecare providers to treat patient signs and symptoms; and the impact that dry eye has on patients' quality of life. Several good studies have been conducted in an attempt to quantify the effect of dry eye on individuals' lives. Let's review some of these studies so we can begin to understand the deleterious effect that dry eye may have on day-to-day activities and quality of life.

Sjögren's Syndrome Impact

In a UK study published in the British Journal of Rheumatology, Thomas and associates (1998) used a population-based survey to evaluate the prevalence and impact of Sjögren's syndrome. They surveyed 1,000 individuals using a postal questionnaire that targeted symptoms such as dry eyes and dry mouth. In a follow-up survey, they used the Medical Outcome Short Form-36, a well recognized survey that evaluates eight critical areas of quality of health. This survey was assessed in individuals who were positively identified as having Sjögren's syndrome. The researchers also used the Health and Fatigue Questionnaire (HFQ) to assess depression and anxiety in the same population.

The results of this study were surprising, if not shocking. Patients identified as having Sjögren's syndrome had poorer scores in physical functioning, bodily pain, general mental health, general health perception, vitality, physical and emotional functioning, and social functioning. In other studies, general health and fatigue were scored worse in Sjögren's positive individuals. This study validates the clinical impression that patients with severe dry eye suffer from general reduction in physical functioning and, specifically, reduced quality of mental health.

Comparing Dry Eye to Other Health Conditions

It's often useful to compare the impact of an ocular condition with that of non-ocular health conditions to get some idea of the effect of ocular conditions on patient quality of life. Schiffman et al (2003) compared utility assessments for health outcomes and, using standardized health-related questionnaires, compared the impact of dry eye states to other health conditions. The authors compared the utility score reported for dry eye with those reported for other health problems not related to vision. Their conclusions may surprise you.

They used what's called the time-trade-off method, in which patients essentially decide how many months or years of their lives they would be willing to give up to be rid of their condition. These values have been determined for a large number of systemic conditions. Researchers found that the value of severe dry eye was equivalent to that assigned to severe angina or disabling hip fracture. The value for mild dry eye was roughly equivalent to that of psoriasis. Respondents stated that they would be willing to give up 1.6 years of their lives to be free of severe dry eye.

The Take Home Message

What it all boils down to is that dry eye has a deleterious effect on our patients' lives, and we probably vastly underestimate its importance. We need to understand that in terms of day-to-day living, our ability to effectively manage dry eye, especially the more severe forms, can have as much impact on quality of life as if we treated a patient's angina. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #154.

Dr. Townsend practices in Canyon, Texas and is an adjunct faculty member at UHCO. E-mail him at drbilltownsend@gmail.com.