The Impact Of Dry Eye Disease On Quality Of Life: A Review Of Literature And Identification Of Research Gap

Literature Review

Dry eye disease is also known as keratoconjunctivitis is a multifactorial disease of the ocular surface and the tears that cause visual disturbances discomfort and instability of the tear film (Friedman 2010). The core mechanism of the condition is the increased tear osmolality and the instability of the tear film. This report aims to focus on the quality of life of the patients with dry eyes diseases (Friedman 2010). In order to put light on this fact 10 literatures have been reviewed to enquire about the currents researches and the findings elated to DED. Finally the report would conclude with a gap identified in the research.  

Although the terminology for DED has been varied over time but it has long been considered as a common condition. In Australia about 1 million people older than 50 years have been found to be suffering from the DED. The global prevalence of DED is about 35 %. This condition has not only been found in elderly patients but also students. Some of the risk factors associated with the DED are age, hormonal changes, female sex, and diabetes, ocular surface abnormalities, reduced corneal sensation, reduced blinking and lacrimal gland deficiencies.

In spite of the high prevalence of DED, it is often misdiagnosed and inadequately addressed. The cost for DED has been estimated to be ranging between $300 and $1100 per patient yearly, with additional costs for impaired productivity, and economic effect on healthcare systems (Labetoulle et al., 2016).

Quality of life encompasses emotional, physical, social and psychological concepts. According to this paper an altered visual performance have been found to be decreasing the quality of life in the people. Some of the common symptoms that have been identified are stinging sensation, blurred vision. Patients suffering from Sjogren’s syndrome have reported that the occurrence of the dry eye interferes with daily activities at an average of 123 days in a year. In relation to this findings, the paper by (Lackner et al. 2017) it has been found that part from dryness and pain, secondary problems are also associated with DED, that is painful dry mucosae, sleeping disorders, inability to eat or chew, recurrent inflammation of the ears and the eyes, fatigue, shortness of breath. Patients have also reported of constipation and shortness of breath. These physical dimensions were also relevant to the psychological and social life of the patients. A study conducted with a focus group regarding the quality of the life of the patient, have revealed that the symptoms are posing psychological and physical challenges and emotional challenges because of the lack of understanding by the relatives, difficulties at work and restricted social life. On the other hand Wong et al., (2017), have stated the association of migraine with dry eye syndrome. Wong et al. (2017), have found that patients having migraine have faced problems related to dry eyes. When the severity and the features of headache were compared with the tears osmolality score, which indicates towards the relationship between the dry eyes and the migraine. This fact can be supported by the study by Koktekir et al., (2012), an increased frequency of the aggravation of the migraine attacks have been related to the dry eye syndrome. However it has not been extensively studied as to whether the disorder can precipitate a migraine attack.

Conclusion

A study performed in the eye center of the Peking University has confirmed that people with DED can have dangerous driving experiences. As per the findings about 10.33% of the participants have reported to have been met with accidents and near accidents (Wang et al. 2017).

Supporting this fact Labetoulle et al. (2016), have stated that severe DED affects the quality of life of the patient to a similar degree as angina, a condition that 16% of the patient would give up life to amend. According to Wang et al. (2017), the vision related quality of life is severely deteriorated due to the dry eyes syndrome. Labetoulle et al., (2016), have also described about the perception of the patients about DED. The negative perception of the disease impacted the quality of life. An online survey was conducted along five European countries to understand about the experiences of the patients with DED. The findings identified a relationship between the delayed diagnoses, negative disease perception, and relief treatment with low quality of life. Delayed diagnosis, in availability of primary care facilities related to DED has been reported by the patients.

Describing about the difficulty in the diagnosis of DED, the symptoms overlap with some other ocular surface pathologies like allergies (Labetoulle et al., 2016). The diagnostic tests for the assessment of the DED are not much reliable although most of the ophthalmologists and the optometrists have indicated that dry eye questionnaire and patient history evaluation are the most preferred instrument for the diagnosis of the DED. The author have stated that visual analogue scale and Likert scale are the self-reporting device that can be used to determine the patients’ symptom. On the other hand Barabino et al., (2016), have validated the use of Snellen or the logvMAR charts to measure the visual equity of the patient. The Ocular surface disease Index is a 12 item questionnaire to assess the intensity of the ocular disturbances.

According to Kanellopoulos & Asimellis, (2016), in spite of this disease being a common clinical problem for most of the patients and the clinicians, there are no globally accepted guidelines for the diagnosis of the dry eyes. The clinical tests that are available for the diagnosis cannot be considered as the gold standard. Most of the techniques that are involved in the diagnosis of the disease has a large degree of subjectivity. Another problem is that there is no clear cut threshold for the assessment of the early stage dry eye definite assessment. This factor hinders the adoption if the cut of values of any traditional techniques. It is to be noted that not every individual possess the same threshold for the symptoms but there lies a range in the population. However there is a need of an accurate assessment technique (Kanellopoulos & Asimellis, 2016). On the contrary Kamao et al., (2011), have stated that Occular surface thermographer is a newly defined noninvasive technique for measuring the ocular surface temperature. In this device the temperature of three regions are measured, the nasal conjunctiva, the central cornea, and the temporal conjunctiva. Studies have shown that this device can highly detect whether the surface temperature has changed with the dry eyes. However the study did not mention, how the quality of life of the people will be improved with this screening technique.

References

Conclusion

In conclusion it can be said that most of the papers supported the fact that dry eye diseases can decrease the quality of life by affecting the visual quality and migraine. Significant impact has also been found in the migraine patients, but only few studies related to this can be found in Australian context, while most of the studies focused on aged population. However several pieces of research has been found in China, Japan and U.S context, which has helped in providing a critique against the quality of life of the people with DED.

One of the research gap in related to this topic is that dry eyes conditions are often underdiagnosed due to the lack of proper screening methods. This is important because the symptoms of dry eyes are confused with other ocular surface disturbances and none of the presenting techniques can serve as gold standard techniques. Most of the papers that has been found does not contain information about how a proper gold standard diagnosis of DED can be made on the basis of which interventions can be taken.

References

Barabino, S., Labetoulle, M., Rolando, M., & Messmer, E. M. (2016). Understanding symptoms and quality of life in patients with dry eye syndrome. The ocular surface, 14(3), 365-376.

Friedman, N. J. (2010). Impact of dry eye disease and treatment on quality of life. Current opinion in ophthalmology, 21(4), 310-316.

Kamao, T., Yamaguchi, M., Kawasaki, S., Mizoue, S., Shiraishi, A., & Ohashi, Y. (2011). Screening for dry eye with newly developed ocular surface thermographer. American journal of ophthalmology, 151(5), 782-791.

Kanellopoulos, A. J., & Asimellis, G. (2016). In pursuit of objective dry eye screening clinical techniques. Eye and Vision, 3, 1. https://doi.org/10.1186/s40662-015-0032-4

Koktekir, B. E., Celik, G., Karalezli, A., & Kal, A. (2012). Dry eyes and migraines: is there really a correlation?. Cornea, 31(12), 1414-1416.

Labetoulle, M., Rolando, M., Baudouin, C., & van Setten, G. (2016). Patients’ perception of DED and its relation with time to diagnosis and quality of life: an international and multilingual survey. British Journal of Ophthalmology, bjophthalmol-2016.

Lackner, A., Ficjan, A., Stradner, M. H., Hermann, J., Unger, J., Stamm, T., … & Dejaco, C. (2017). It’s more than dryness and fatigue: The patient perspective on health-related quality of life in Primary Sjögren’s Syndrome-A qualitative study. PloS one, 12(2), e0172056.

McMonnies, C. W. (2016). Measurement of symptoms pre-and post-treatment of dry eye syndromes. Optometry and Vision Science, 93(11), 1431-1437.

Wang, Y., Lv, H., Liu, Y., Jiang, X., Zhang, M., Li, X., & Wang, W. (2017). Characteristics of symptoms experienced by persons with dry eye disease while driving in China. Eye, 31(11), 1550.

Wong, M., Dodd, M. M., Masiowski, P., & Sharma, V. (2017). Tear osmolarity and subjective dry eye symptoms in migraine sufferers. Canadian Journal of Ophthalmology/Journal Canadien d’Ophtalmologie, 52(5), 513-518.