JAMA Ophthalmology, February 2017
Although risk factors for dry eye syndrome have been elucidated by cross-sectional studies, little information exists about symptom progression and persistence over time. In a longitudinal study, Ong et al. found that most patients who had severe symptoms of dry eye at baseline reported persistence of those symptoms 1 year later.
The study population comprised 120 patients (mean age, 64 years) recruited from Miami Veterans Affairs System eye clinic. At baseline, signs and symptoms of dry eye ranged from none to severe. Because the study focused on idiopathic dry eye, researchers excluded individuals with corneal or eyelid abnormalities; contact lens use; prior refractive, glaucoma, or retinal surgery; ocular medication use (except artificial tears); and ocular or systemic conditions associated with dry eye.
At baseline, each participant provided information on demographics, ocular and medical history, and use of medications; they also self-reported their eye pain on a numerical scale and completed standardized questionnaires including the Dry Eye Questionnaire 5 (DEQ5), Ocular Surface Disease Index, and the Neuropathic Pain Symptom Inventory modified for the eye. Ocular surface evaluation was also performed at baseline. The questionnaires were administered again at 1 year, to assess change from baseline and determine risk factors associated with severe dry eye symptoms at 1 year.
At baseline, 58 patients had absent, mild, or moderate symptoms of dry eye. Of these, 26 (45%) progressed to more severe symptoms at 1 year. Of the 62 patients who had severe symptoms (a score of ≥12 on the DEQ5) at baseline, 46 (74%) reported that their symptoms persisted during the follow-up year.
Baseline ocular risk factors for severe dry eye symptoms at 1 year included more severe dry eye symptoms, ocular pain, and neuropathic pain–like ocular symptoms. Nonocular risk factors included sleep disturbances (e.g., sleep apnea, insomnia), mental health status (e.g., depression, posttraumatic stress disorder [PTSD]), nonocular pain, and medication use (e.g., anxiolytics, analgesics). The most significant risk factors were found to be sleep apnea (odds ratio [OR], 3.80), DEQ5 score (OR, 1.15), and PTSD (OR, 1.04).
The authors concluded that patients with severe dry eye symptoms and ocular pain at baseline are more likely to experience continuation of those symptoms. Individual pain perception and severity are important considerations in the evaluation and management of patients with dry eye. Further, the authors recommended that dry eye assessment should be expanded to include questions about the time course, pain severity, and neuropathic qualities of dry eye symptoms.
The original article can be found here.