Dry eye disease severity and impact on quality of life in type II diabetes mellitus

Tetiana Zhmud; Natalia Malachkova; Robert Rejdak; Ciro Costagliola; Marina Concilio; Galyna Drozhzhyna; Damiano Toro Mario; Svitlana Veretelnyk

doi:10.3389/fmed.2023.1103400

Dry eye disease severity and impact on quality of life in type II diabetes mellitus

Front Med (Lausanne). 2023 Feb 27:10:1103400. doi: 10.3389/fmed.2023.1103400. eCollection 2023.

Authors

Tetiana Zhmud¹, Natalia Malachkova¹, Robert Rejdak², Ciro Costagliola³, Marina Concilio⁴, Galyna Drozhzhyna⁵, Damiano Toro Mario^{2

6}, Svitlana Veretelnyk¹

Affiliations

¹ Department of Ophthalmology, National Pirogov Memorial Medical University, Vinnytsia, Ukraine.
² Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland.
³ Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy.
⁴ Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy.
⁵ Department of Corneal Pathology, SI "Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine", Odesa, Ukraine.
⁶ Eye Clinic, Public Health Department, University of Naples Federico II, Naples, Italy.

Abstract

Aim: To assess the severity of dry eye disease (DED) in humans, its impact on quality of life (QoL) and to grade the damage incurred by the anterior ocular surface in patients diagnosed with type 2 diabetes mellitus (T2DM).

Patients and methods: Forty-six patients (mean age ± SD = 63.8 ± 6.7 years) diagnosed with T2DM were enrolled in the experimental group and 26 healthy individuals constituted the control group (67.9 ± 8.9 years). The diagnosis and gradation of DED were conducted in accordance with the International Task Force severity grading scheme. Disease-specific questionnaires were used to obtain the Ocular Surface Disease Index (OSDI) and assess the negative effects of the disease on the patient's QoL. The severity of conjunctival redness and corneal/conjunctival staining was assessed by Efron and Oxford scales, respectively.

Results: According to OSDI scores, the entire experimental group presented symptoms of DED: 54.4% were diagnosed with mild DED and 46.6% with moderately severe DED. No cases of severe DED were diagnosed in either the experimental or control group. In the control group, 57.7% of individuals did not have the disease. A significant difference between the experimental and control groups was recorded for both OSDI scores (p < 0.01) and health-related QoL (p < 0.01). It was observed that keratopathy influenced the mean OSDI values of patients. The mean OSDI value was 25.14 ± 3 in the experimental group diagnosed with keratopathy, 19.3 ± 3.5 in the subgroup with no indications of corneal injury (p = 0.000002), and 13.0 ± 3.0 in the control group (p < 0.000002). Based on the DEWS scheme, a grade I severity level was observed in 46% of control subjects and 33% of patients diagnosed with T2DM (p = 0.4915); grades II and III were detected in the bulk of the experimental group (p = 0.0051; p = 0.1707). None of the subjects in the control or experimental groups manifested grade IV severity of DED.

Conclusion: In comparison to healthy adults, DED adversely impacts the QoL of type 2 DM patients, regardless of the disease's association with keratopathy.

Keywords: Oxford scale; dry eye disease; ocular surface disease index; quality of life; type 2 diabetes mellitus.