Statins, Dyslipidemia, and Dry Eye

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Statin use and dyslipidemia appear to be broadly associated with dry eye disease (DED), according to a large retrospective study of patients treated at the University of North Carolina (UNC) ophthalmic clinics.

In a cohort of 39,336 people, the odds of being diagnosed with DED were approximately 40% greater in people taking statins and 60% greater for those with a total cholesterol greater than 200 mg/dL. As for lipid fractions, the odds of being diagnosed with DED were 40% to 50% greater in patients with low high-density lipoprotein (<40 mg/dL), elevated low-density lipopro­tein (>130 mg/dL), and high triglycerides (>150 mg/dL).¹ The intensity of the statin therapy did not appear to have any impact on the DED incidence.

Previous findings on a potential association between DED risk and dyslipidemia or lipid therapy have been mixed. “Although previous studies of smaller, select populations support an association between dyslipid­emia and MGD [meibomian gland dysfunction] or DED, none of those studies have specifically evaluated the association of statin use/intensity and a clinical diagno­sis of DED,” the UNC researchers wrote.¹

Lack of clarity. The researchers eliminated patients with confounding factors, such as autoimmune diseases or concomitant use of antihistamines and other medi­cations, from the original cohort of 72,931 patients seen over a 10-year period. However, it is possible that other potential confounding factors might have affected the odd ratios, they wrote.

Commenting on the study, Bennie H. Jeng, MD, agreed, noting that other issues make it difficult to draw definitive conclusions based on the study. These factors include classification of the subjects as having DED based solely on coding and not on objective tests or assessments for dry eye or MGD. In addition, the older ICD-9 coding was used for most subjects in the study, so the MGD diagnosis code (found in ICD-10 coding) was not used.

“The authors [of this study] could not confirm the diagnosis, and there are many confounders that they couldn’t control for,” said Dr. Jeng, at the University of Maryland School of Medicine in Baltimore.

“Furthermore, some of the patients diagnosed with dyslipidemia may have been seen at eye care providers outside of the UNC system, and this could skew the results,” he noted.

Need for prospective research. Despite these concerns, the study’s results suggest that prospective studies of this topic—with more diagnostic rigor and adjustment for all confounding factors—are warranted, Dr. Jeng said.

—Linda Roach

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1 Aldaas KM et al. Am J Ophthalmol. 2020;218:54-58.

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Relevant financial disclosures—Dr. Jeng: EyeGate Pharmaceu­ticals: O; GlaxoSmithKline: C; Merck: C.

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