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Early diagnosis of dry eye important for quality of life1

A/Prof Michael Lawless

01/09/2017

Early diagnosis of dry eye important for quality of life

Dry eye is an insidious and often overlooked/undertreated disease affecting up to a third of adults worldwide. As its name suggests, dry eye is a condition where there is a less-than-optimal covering of tears across the eyes, either because of insufficient tear production, poor tear quality or increased tear evaporation. There is commonly accompanying inflammation of the surface of the eye. Early diagnosis and initiation of dry eye treatment may be able to prevent disease progression and the long-term effects that could potentially damage the eye surface and impair vision. Untreated cases may result in pain, corneal ulcers, corneal scars and potentially loss of vision (although this is rare).

Dry eye is commonly confused with other conditions

Diagnosis remains challenging

A challenging part of dry eye diagnosis is the variability and subjectivity of symptoms, and the vocabulary used by patients to describe symptoms. Consequently, dry eye is commonly confused with other conditions, in particular allergies. The lack of a definitive diagnostic tool and standard diagnostic pathway presents a further barrier. Eye care professionals may use a combination of tests, such as:

  • Schirmer tear test
  • tear-film osmolarity test
  • tear breakup time
  • corneal fluorescein staining
  • symptom questionnaires (e.g. Ocular Surface Disease Index, Visual Analog Scale, System for Patient Evaluation of Eye Dryness, and Symptom Assessment in Dry Eye).

QoL negatively affected

The detrimental effects (physical, mental, financial) of dry eye are not to be taken lightly. Sufferers may have reduced ability to undertake common everyday tasks (e.g. looking at a computer screen or reading for extended periods) and this may also impair productivity in the workplace. Tolerance to dry environments, such as those with heating/air conditioning, is reduced. Studies indicate that the economic burden on some healthcare systems is similar to that seen with rheumatoid arthritis. Additionally, severe dry eye affects patient quality of life (QoL) on a comparable level with severe angina (chest pain related to heart disease).

International study provides new insights

Findings from a large, international, observational study of patients’ experience with dry eye and its effect on their QoL were recently published in the British Journal of Ophthalmology. This European study, the first of its kind to also examine the effect of pre-diagnosis history, included 706 patients from five countries. All patients had a confirmed diagnosis of dry eye and had been using artificial tears daily for at least six months.

Key findings from the survey:

  • 97% of patients were unaware that dry eye is a chronic condition
  • 31% of patients perceived dry eye as a ‘disease’ or ‘handicap’
  • Delay of > 1 year between symptom onset and dry eye diagnosis is associated with low QoL
  • Frequent use of relief treatments (≥ 3 times daily) is associated with low QoL
  • Relief treatments were more commonly used by patients who had a delayed diagnosis (> 1 year) of dry eye
  • Having to see more than one healthcare professional before a diagnosis of dry eye was confirmed is linked to lower QoL
  • Having a negative perception of dry eye is linked to low QoL
  • The top four descriptive terms for symptoms chosen from a pre-determined list were ‘dry’, ‘itchy’, ‘foreign body sensation’ and ‘sore/irritated’
  • A keyword-combination approach to symptom description may be a useful aid to diagnosis.

The Jennifer Aniston effect

‘I was addicted to eye drops.’2

Jennifer Aniston

Luckily, awareness of dry eye is beginning to gain traction with some help from the Eyelove campaign by pharmaceutical company Shire. Executives from Shire, who recently launched a new dry eye treatment, heard about well-known actress Jennifer Aniston’s addiction to eye drops from an interview she gave and contacted her. Aniston went to see an ophthalmologist and was subsequently diagnosed with dry eye. Now she happily shares her story to help others like her.

In summary, if you can’t bear to be parted from your eye drops (whether it be artificial tears or ‘red eye’ drops) or feel like your eyes are burning or itchy, contact your eye care professional for further investigation.

Vision Eye Institute has a number of ophthalmologists who specialise in the diagnosis and treatment of dry eye. Click here for details.

Dr Michael Lawless is one of Australia’s most experienced eye surgeons and has performed over 30,000 vision correction procedures, including ASLA, LASIK and SMILE. He practises at Vision Eye Institute Bondi Junction, Vision Eye Institute Hurstville and Vision Eye Institute Chatswood.

References

  1. Labetoulle M et al. Patients’ perception of DED and its relation with time to diagnosis and quality of life: an international and multilingual survey. Br J Ophthalmol 2016;0:1–6.
  2. http://www.foxnews.com/health/2016/08/30/jennifer-aniston-was-addicted-to-eye-drops.html. Accessed online 23 February 2017

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