Relationship between dry eye symptoms and quality of life: associations and mediation analysis

Elizabeth Wen Ling Lim; Crystal Chun Yuen Chong; Simon Nusinovici; Eva Fenwick; Ecosse Luc Lamoureux; Charumathi Sabanayagam; Ching-Yu Cheng; Louis Tong

doi:10.1136/bjo-2022-321246

Relationship between dry eye symptoms and quality of life: associations and mediation analysis

Br J Ophthalmol. 2023 Nov;107(11):1606-1612. doi: 10.1136/bjo-2022-321246. Epub 2022 Aug 8.

Authors

Elizabeth Wen Ling Lim¹, Crystal Chun Yuen Chong¹, Simon Nusinovici¹, Eva Fenwick^{1

2}, Ecosse Luc Lamoureux^{1

3}, Charumathi Sabanayagam^{1

2}, Ching-Yu Cheng^{1

2

4}, Louis Tong^{5

2

6}

Affiliations

¹ Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore.
² Eye Academic Clinical Program, Duke-NUS Medical School, Singapore.
³ Health Services and System Research, Duke-NUS Medical School, Singapore.
⁴ Glaucoma, Singapore National Eye Centre, Singapore.
⁵ Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore louis.tong.h.t@singhealth.com.sg.
⁶ Corneal and External Eye Disease, Singapore National Eye Centre, Singapore.

PMID: 35940854
DOI: 10.1136/bjo-2022-321246

Abstract

Purpose: (1) To determine the independent association of dry eye symptoms with health-related quality of life (HRQoL) in the Singapore population and (2) to further investigate which factors mediate this association.

Methods: In this cross-sectional study, 7707 participants were included. The presence of dry eye symptoms was defined as experiencing at least one out of the six symptoms either 'often' or 'all the time'. The EuroQoL-5 dimensions (EQ-5D) utility instrument (raw scores converted to UK time trade-off (TTO) values) was used to assess generic HRQoL and the overall score from the Visual Functioning Questionnaire for visual functioning. The association between dry eye symptoms and EQ-5D was investigated using multivariable linear regression, adjusting for demographic and socioeconomic information, comorbidities, systemic and ocular examinations results. Mediation analysis was used to determine whether certain factors mediated this association.

Results: After adjusting for relevant factors, those with dry eye symptoms had significantly lower HRQoL (difference in EQ-5D TTO: -0.062 (95% CI -0.073 to -0.050)), with the inability to open eyes affected the most (-0.101 (95% CI -0.161 to -0.042)), followed by a sandy sensation (-0.089 (95% CI -0.121 to -0.058)), a burning sensation (-0.070 (95% CI -0.105 to -0.036)), red eyes (-0.059 (95% CI -0.082 to -0.036)), a dry sensation (-0.058 (95% CI -0.072 to -0.044)) and crusting of eyelids (-0.040 (95% CI -0.071 to -0.008)). Visual functioning and the presence of recent falls accounted for 8.63% (4.98%-14.5%) and 2.93% (0.04%-5.68%) of the indirect relationship between dry eye and HRQoL, respectively.

Conclusion: Dry eye symptoms were independently associated with poor HRQoL. Moreover, this was partly mediated by reduced visual functioning and experiencing recent falls. Our results suggest that efforts to reduce severity of dry eye symptoms are essential to optimise patients' overall functioning and well-being.

Keywords: cornea; epidemiology; ocular surface; tears.