Results from a national survey recently examined dry eye disease and its potential impact on patients in the United States. Specifically, results from the National Eye C.A.R.E. (Current Attitudes Related to Eye Health) Survey^1,2—conducted by Harris Poll on behalf of Shire and released in October 2016—highlight that dry eye disease prevalence in the United States may be expanding; the patient demographics increasingly include younger adults, suggesting that these shifts are caused in part by America’s growing reliance on digital devices and increased daily “screen time” (i.e., time spent looking at mobile, tablet, computer, and video screens). The survey was conducted online between July 6 and 27, 2015. The professional arm of the survey included 1,015 U.S. adults ages 18+ who are optometrists (n = 502) or ophthalmologists (n = 513) (a.k.a., eyecare practitioners [ECPs]). The consumer arm of the survey included a total of 1,210 U.S. adults ages 18+ who reported dry eye symptoms (“adults who have dry eye symptoms”), including 375 adults who have been diagnosed with dry eye disease (or chronic dry eye) by a healthcare professional (“patients”) and 835 adults who have not been diagnosed, but experience dry eye symptoms and have used artificial tears to relieve those symptoms within the past month. The results may provide a helpful resource to physicians when initiating conversations about dry eye with their patients.

This article provides the first look at the National Eye C.A.R.E. Survey’s subset analysis of adults who have dry eye symptoms and who wear contact lenses (“contact lens wearers,” n = 288) in comparison with those who do not (“non-contact lens wearers,” n = 922). While the experiences of adults who have dry eye symptoms were similar regardless of contact lens use in some areas, important differences emerged in the analysis.

The article also reviews some of the topline survey results among ECPs and the total population of adults who have dry eye symptoms in general to provide context for the subset analysis.

THE IMPACT OF SCREEN TIME ON DRY EYE SYMPTOMS IN LENS WEARERS

In the National Eye C.A.R.E. Survey, nearly nine of 10 ECPs (89%) said they believe that Americans’ modern, multi-screen lifestyle is responsible for an increase in dry eye disease and that the condition is becoming increasingly common. A similar observation also was reported among the surveyed adults who have dry eye symptoms; more than half (53%) blamed screen time, including computers, TVs, hand-held electronics, and video games, for contributing to their symptoms more than any other factor (Figure 1).

Among surveyed adults who have dry eye symptoms, contact lens wearers were more likely compared to non-contact lens wearers to cite screen time as a contributing factor to their dry eye symptoms (69% versus 48%). Likewise, this subset of adults also selected other contributing factors more often than did non-contact lens wearers, including allergies (55% versus 41%), lack of sleep (44% versus 27%), contact lens use (52% versus 13%), smoking (25% versus 14%), and poor diet (20% versus 13%).

SYMPTOM ONSET OCCURRING EARLIER, PARTICULARLY AMONG LENS WEARERS

In addition to reinforcing a potential link between tech-dependency and growing frequency of dry eye symptoms, the survey results also suggest that modern lifestyles may have led to a noticeable shift in the face of the condition, with patient demographics skewing toward younger adults over the past decade.

Among the ECPs surveyed, 76% reported observing more patients between the ages of 18 to 34 having dry eye symptoms compared with 10 years ago. While women over the age of 50 are still considered most at risk for dry eye disease,³ the average age of symptom onset reported among all of the adults surveyed was 36 years.

For the contact lens wearers who were surveyed, symptom onset occurred even earlier. On average, contact lens wearers reported symptom onset more than 10 years earlier compared to non-contact lens wearers, with a mean age of symptom onset of approximately 27 years among contact lens wearers versus approximately 36 years among non-contact lens wearers (Figure 2). Collectively, the results support the ongoing efforts toward dry eye screening in young adult patients, particularly those who wear contact lenses.

IMPACT OF DRY EYE SYMPTOMS GREATER AMONG CONTACT LENS WEARERS

When asked how dry eye symptoms make them feel and how those symptoms affect daily activities, contact lens wearers were more likely compared to non-contact lens wearers to report negative feelings and a more pronounced impact on several areas. For example, contact lens wearers were more likely compared to non-contact lens wearers to say that their dry eye symptoms make them feel older than they actually are (61% versus 51%) (Figure 3) or to report feeling annoyed (67% versus 54%), tired (53% versus 44%), frustrated (52% versus 39%), and unattractive (24% versus 10%) (Figure 4).

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In addition, contact lens wearers were more likely compared to non-contact lens wearers to report that dry eye symptoms impact them in nine of 11 categories evaluated (ability to spend time in front of a screen; other aspects of eye care/eye health; job/career or ability to work; ability to perform daily activities; self-esteem; social life; relationships with friends; relationships with family; and relationships with spouse or significant other). Higher percentages of contact lens wearers reported that their symptoms impact them in all 11 of the categories that were examined, but the difference was not statistically significant in the remaining two (ability to participate in hobbies and physical appearance) (Figure 5).

Contact lens wearers surveyed were more likely compared to non-contact lens wearers to report avoiding activities that they know will cause their dry eye symptoms (65% versus 53%), that their symptoms often keep them from what they want to be doing (51% versus 41%), and that their symptoms make it difficult for them to participate in everyday activities (49% versus 36%).

Contact lens wearers were also more likely compared to non-contact lens wearers to take certain steps to address their symptoms, including getting punctal plugs (16% versus 5%), intense pulsed light (16% versus 2%), or thermal pulsation therapy (13% versus 2%). In addition, they were more likely compared to non-contact lens wearers to use artificial tears at least five times per day (19% versus 8%). Despite these measures, however, more contact lens wearers believed that their symptoms were getting worse over time (62% versus 49% for non-contact lens wearers).

STARTING THE DISCUSSION WITH YOUR PATIENTS

This national survey offers several reasons why ECPs may want to initiate a dry eye dialogue with all of their adult patients regardless of age, and it may also provide a helpful resource for physicians who are initiating conversations with contact lens wearers about dry eye symptoms.

First, these results reinforce that the growing frequency of dry eye disease may be linked to America’s growing reliance on personal devices and other screen-based modern technology. Second, patient and ECP responses suggest that dry eye symptoms are appearing in some adults at younger ages than in years past, and many ECPs (89%) believe that dry eye disease is more common because of today’s multi-screen lifestyle. Third, some of the patients surveyed said that dry eye symptoms impact them in many ways, cause them to avoid activities, and keep them from what they want to be doing.

In spite of the last point, nearly seven in 10 adults surveyed who have dry eye symptoms (69%) felt like those symptoms are just something they have to live with (the rate was similar regardless of contact lens use—69% of contact lens wearers reported feeling this way, as did 68% of non-contact lens wearers).

Lastly, looking at the survey results, more than half of adults who have dry eye symptoms (57%) said that they wished they had spoken with their ECP about their symptoms sooner. This was true for contact lens wearers and non-contact lens wearers alike (62% of contact lens wearers, 55% of non-contact lens wearers). But, in many cases, adults in the survey who have dry eye symptoms said that they didn’t believe their symptoms were worth mentioning simply because they weren’t asked about the disease by their ECP (45% of all adults with dry eye symptoms surveyed)—and contact lens wearers were more likely than non-contact lens wearers to report feeling this way (52% versus 42%).

Given the survey results, ECPs may consider proactively engaging in a dialogue about dry eye symptoms and screening patients for dry eye disease as part of a regular eye exam. CLS

Acknowledgment:

Dr. Nichols acknowledges Shire for the company’s support in developing the content for this article.

REFERENCES

1. Shire National Eye C.A.R.E. Survey conducted by Harris Poll – Professional Findings. Field Period: July 6 to 27, 2015.
2. Shire National Eye C.A.R.E. Survey conducted by Harris Poll – Consumer Findings. Field Period: July 6 to 22, 2015.
3. Schaumberg DA, Sullivan DA, Buring JE et al. Prevalence of dry eye syndrome among US women. Am J Ophthalmol. 2003 Aug;136:318-326.