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Chang L, Guo Q, Pazo EE, Li F, Zhang Z, Fang Z, Huang Y, Yang R, Liu H, Li X, Zhang C, Zhao S. Prevalence of dry eye in people over 50 years old in Beichen district, Tianjin city: a cross-sectional population-based survey. BMC Public Health 2024; 24:2111. [PMID: 39103841 DOI: 10.1186/s12889-024-19616-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/26/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND A cross-sectional population-based survey in the Beichen district of Tianjin was conducted to estimate the prevalence of dry eye disease (DED) among the population over 50 years old with Dry Eye Workshop (DEWS) II and Chinese expert consensus (CEC) criteria. METHODS A total of 5791 subjects over 50 years old were enrolled. Ocular surface disease index (OSDI) questionnaire, lipid layer thickness (LLT), partial blink ratio (PBR), fluorescein tear film breakup time (FBUT), Schirmer I test (SIT), fluorescein staining, meibomian gland dropout, meibomian gland expression scores (MES) and quantity scores (MQS) was assessed. Additionally, basic information, weight, disease history, living habits, anxiety, and depression condition were collected. RESULTS According to the CEC, the prevalence of DED was 39.0%, whereas 44.0% based on DEWS II. The prevalence of DED increased with age and was substantially greater among women (41.1%, 95% CI, 39.5-42.6%) than males (35.1%, 95% CI, 33.1 -37.2%) (p < 0.001). Furthermore, the severity of DED was more severe in women (p = 0.006). The associated risk factors were age, female, depression, smoking, insomnia, and glaucoma. On the other hand, 53.6% of these populations were diagnosed as asymptomatic DED, and the morbidity was higher in males (p = 0.007). CONCLUSIONS The prevalence of DED in China was relatively high, which was associated with aging, female(sex), depression, smoking and sleep problems. Hence, it is crucial for clinicians and caregivers to be aware of the existence of asymptomatic DED within the susceptible population.
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Affiliation(s)
- Lianqing Chang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Qian Guo
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Emmanuel Eric Pazo
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Fei Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - ZhongFang Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Zijie Fang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yue Huang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Ruibo Yang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Hui Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Chen Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.
| | - Shaozhen Zhao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.
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Tawfik A, Pistilli M, Maguire MG, Chen Y, Yu Y, Greiner JV, Asbell PA, Ying GS. Association of Dry Eye Symptoms and Signs in Patients with Dry Eye Disease. Ophthalmic Epidemiol 2024; 31:274-282. [PMID: 37592829 PMCID: PMC10873469 DOI: 10.1080/09286586.2023.2248629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/07/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE To determine the correlations among symptoms and signs of dry eye disease (DED) in the Dry Eye Assessment and Management (DREAM) study. METHODS A total of 535 patients with moderate-to-severe DED were assessed for symptoms using the Ocular Surface Disease Index (OSDI) and four DED signs in both eyes (conjunctival lissamine green staining, corneal fluorescein staining, Schirmer's testing, and tear break-up time (TBUT)) following standardized protocols at baseline and follow-up visits (months 3, 6, and 12). Spearman correlation coefficients (rho) were calculated for correlations among symptoms and signs of DED at baseline and among changes in symptoms and signs from baseline at 12 months. The confidence intervals and p-values for correlation coefficients were calculated using a cluster bootstrapping to account for inter-eye correlation. RESULTS At baseline, OSDI total score was not correlated with signs; however, OSDI subscale score of ocular symptoms was weakly correlated with corneal staining score (rho = 0.14, p = .002) and Schirmer test score (rho = 0.11, p = .01). There were statistically significant correlations among the four signs (p < .001), with absolute correlation coefficient ranging from 0.14 (conjunctival staining score vs. TBUT) to 0.33 (conjunctival staining score vs. cornea staining score). The correlations among changes in symptoms and signs were weaker, with the highest correlation between change in conjunctival staining and corneal staining (rho = 0.21, p < .001). CONCLUSIONS Consistent with previous studies, among DREAM participants with moderate-to-severe DED at baseline, correlations of DED symptoms with signs were low and correlations among four objective signs were low to moderate. The correlations among changes in symptoms and signs were even weaker.
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Affiliation(s)
- Andrew Tawfik
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Maxwell Pistilli
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maureen G Maguire
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yineng Chen
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yinxi Yu
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jack V Greiner
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Penny A Asbell
- Department of Bioengineering, University of Memphis, Memphis, Tennessee
| | - Gui-shuang Ying
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Tang WSW, Lau NXM, Krishnan MN, Chin YC, Ho CSH. Depression and Eye Disease-A Narrative Review of Common Underlying Pathophysiological Mechanisms and their Potential Applications. J Clin Med 2024; 13:3081. [PMID: 38892791 PMCID: PMC11172702 DOI: 10.3390/jcm13113081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Depression has been shown to be associated with eye diseases, including dry eye disease (DED), cataracts, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR). This narrative review explores potential pathophysiological connections between depression and eye disease, as well as its potential correlations with ocular parameters. Methods: A literature search was conducted in August 2022 in PUBMED, EMBASE, and PsycINFO. Published articles related to the subject were consolidated and classified according to respective eye diseases and pathophysiological mechanisms. Results: The literature reviewed suggests that common pathophysiological states like inflammation and neurodegeneration may contribute to both depression and certain eye diseases, while somatic symptoms and altered physiology, such as disruptions in circadian rhythm due to eye diseases, can also influence patients' mood states. Grounded in the shared embryological, anatomical, and physiological features between the eye and the brain, depression is also correlated to changes observed in non-invasive ophthalmological imaging modalities, such as changes in the retinal nerve fibre layer and retinal microvasculature. Conclusions: There is substantial evidence of a close association between depression and eye diseases. Understanding the underlying concepts can inform further research on treatment options and monitoring of depression based on ocular parameters.
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Affiliation(s)
- Wymann Shao Wen Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Nicole Xer Min Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | | | - You Chuen Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Raffles Medical Group, Singapore 188770, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore 119228, Singapore
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Gu Y, Cao K, Li A, Wang J, Guo Y, Hao Y, Tian L, Jie Y. Association between sleep quality and dry eye disease: a literature review and meta-analysis. BMC Ophthalmol 2024; 24:152. [PMID: 38581010 PMCID: PMC10996221 DOI: 10.1186/s12886-024-03416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/27/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE The purpose of this article is to systematically review the association between dry eye and sleep quality. METHODS PubMed, EMBASE, Cochrane, Web of Science, and grey literature databases were searched for observational studies published before April 2023. Meta-analysis was performed using STAT15 software. RESULTS A total of 21 studies with 419,218 participants were included. The results showed that the dry eye subjects had a worse sleep quality than the healthy population, with poorer subjective sleep quality, longer sleep latency, and a higher risk of unhealthy sleep duration such as insufficient sleep or excessive sleep. The Pittsburgh Sleep Quality Index (PSQI) scores of the dry eye subjects were significantly higher than those of the control subjects (WMD = 1.78, 95%CI: 1.06, 2.50, P < 0.001). The dry eye subjects scored higher than the control subjects in sleep quality, sleep latency, and sleep disturbance in PSQI; there was no difference between the dry eye individuals and control subjects in sleep duration, sleep efficiency, daytime dysfunction, and sleep medication scores. The risk of sleep disorders in the dry eye subjects was significantly higher than that in the non-dry eye subjects (RR = 2.20, 95%CI: 1.78, 2.72, P < 0.001); the risk of insufficient sleep in the dry eye subjects was higher than that in the control subjects (RR = 3.76, 95%CI: 3.15, 4.48, P < 0.001), and the prevalence of excessive sleepiness in dry eye subjects was higher than that in the control subjects (RR = 5.53, 95%CI: 3.83, 7.18, P < 0.001). The ESS scores of the dry eye subjects were significantly higher than those of the control subjects (WMD = 3.02, 95%CI: 2.43, 3.60, P < 0.01). CONCLUSION Our meta-analysis suggests that individuals with dry eye have a worse sleep quality than the healthy population, with poorer subjective sleep quality, longer sleep latency, and higher risk of unhealthy sleep duration such as insufficient sleep or excessive sleepiness.
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Affiliation(s)
- Yixuan Gu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, 100730, Beijing, China
| | - Ao Li
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China
| | - Jingyi Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China
| | - Yihan Guo
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China
| | - Yiran Hao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China
| | - Lei Tian
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China.
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China.
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Cutrupi F, De Luca A, Di Zazzo A, Micera A, Coassin M, Bonini S. Real Life Impact of Dry Eye Disease. Semin Ophthalmol 2023; 38:690-702. [PMID: 37095685 DOI: 10.1080/08820538.2023.2204931] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/26/2023]
Abstract
Dry Eye Disease (DED) is an increasingly common condition that affects between 5% and 50% of the global population. Even though DED is most frequently diagnosed in older people, it has also been diagnosed in young adults and adolescents more frequently in recent years (employees, gamers). People can experience different types of symptoms and find it challenging to read, watch TV, cook, climb stairs, and meet friends. Mild and severe dry eye can reduce quality of life similarly to mild psoriasis and moderate-to-severe angina. Furthermore, DED patients experience serious difficulties driving vehicles, especially at night, and show a decrease in work productivity, which, when combined with the relevant indirect cost that this condition produces, poses a serious challenge in our days. In addition, DED patients are more likely to develop depression and suicidal ideations and experience frequent sleep disorders. Finally, it is discussed how lifestyle changes, such as increased physical activity, blinking exercises, and a proper diet, have positive implications for the management of this condition. Our aim is to draw attention to the negative effects of dry eye in real life, which are unique to each patient, especially as they relate to the non-visual symptoms experienced by DED patients.
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Affiliation(s)
- Francesco Cutrupi
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Andrea De Luca
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Antonio Di Zazzo
- Research Laboratories in Ophthalmology, IRCCS Bietti Foundation, Rome, Italy
| | - Alessandra Micera
- Research Laboratories in Ophthalmology, IRCCS Bietti Foundation, Rome, Italy
| | - Marco Coassin
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Stefano Bonini
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
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6
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An Y, Kim H. Sleep disorders, mental health, and dry eye disease in South Korea. Sci Rep 2022; 12:11046. [PMID: 35773440 PMCID: PMC9247087 DOI: 10.1038/s41598-022-14167-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 06/02/2022] [Indexed: 12/02/2022] Open
Abstract
Dry eye disease (DED) is a multifactorial disease of the ocular surface causing severe discomfort, mild ocular irritation, fatigue, pain, visual disturbance, and foreign body sensation. Stress, depression, and sleep disorders are risk factors for DED. We aimed to investigate the association between DED symptoms and composite factors related to mental health (combined sleep duration, psychological stress perception, and history of depressed mood) in Korean adults aged ≥ 20 years in a population-based study using the 2010-2012 Korea National Health and Nutrition Examination Survey data. Symptoms of DED and data on mental health were obtained using questionnaires. Multiple logistic regression analysis was conducted to examine the association between mental health and DED, and adjusted for possible covariates. Subjects with symptoms of DED were more likely to experience short sleep duration, psychological stress perception, and a history of depressed mood [odds ratio (OR) = 1.42, 95% confidence interval (CI) 1.06-1.90; OR = 1.71, 95% CI 1.37-2.14; and OR = 1.37, 95% CI 1.06-1.77, respectively] even after correcting for demographic factors, lifestyle factors, and medical factors. Additionally, participants with symptoms of DED were more likely to experience composite factors related to mental health (OR = 1.91, 95% CI 1.07-3.39). Therefore, ophthalmologists may report difficulties in both sleep and mental health in patients with DED.
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Affiliation(s)
- Youngju An
- Department of Optometry, Baekseok Culture University, Cheonan, 31065, Korea
| | - Hyojin Kim
- Department of Optometry, Division of Health Science, and Graduate School of Health and Welfare, Baekseok University, Cheonan, 31065, Korea.
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7
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Zheng Q, Li S, Wen F, Lin Z, Feng K, Sun Y, Bao J, Weng H, Shen P, Lin H, Chen W. The Association Between Sleep Disorders and Incidence of Dry Eye Disease in Ningbo: Data From an Integrated Health Care Network. Front Med (Lausanne) 2022; 9:832851. [PMID: 35187009 PMCID: PMC8854755 DOI: 10.3389/fmed.2022.832851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate the association between sleep disorders and dry eye disease (DED) in Ningbo, China. METHODS Our data came from the Yinzhou Health Information System (HIS), including 257932 patients and was based on a 1:1 matching method (sleep disorder patients vs. patients without sleep disorders) during 2013-2020. Sleep disorders and DED were identified using ICD-10 codes. Cox proportional hazards regression was used to identify the association between sleep disorders and DED. RESULTS The eight-year incidence of DED was significantly higher in participants with diagnosis of sleep disorders (sleep disorders: 50.66%, no sleep disorders: 16.48%, P < 0.01). Sleep disorders were positively associated with the diagnosis of DED (HR: 3.06, 95% CI: 2.99-3.13, P < 0.01), when sex, age, hypertension, diabetes and other systemic diseases were adjusted. In the sleep disorders patients, advancing age, female sex, and presence of coexisting disease (hypertension, diabetes, hyperlipidemia, thyroid disease, depression, heart disease, and arthritis) were significantly associated with the development of DED by the multivariate cox regression analysis (all P < 0.05).In addition, there was a significantly positive association between estazolam and the incidence of DED in both sleep disorder and non-sleep disorder groups (all P < 0.05). CONCLUSIONS Sleep disrder was associated with a three-time increased risk of DED. This association can be helpful in effective management of both sleep disorders and DED.
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Affiliation(s)
- Qinxiang Zheng
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Saiqing Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Feng Wen
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
| | - Zhong Lin
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Kemi Feng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Yexiang Sun
- Department of Chronic Diseases and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Jie Bao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Hongfei Weng
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
| | - Peng Shen
- Department of Chronic Diseases and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Hongbo Lin
- Department of Chronic Diseases and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Wei Chen
- The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
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8
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Daniel L, Taj M. Dry eye disease in patients with alcohol use disorder. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_157_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Liu Z, Sun S, Sun X, Wu Y, Huang Y. Differences of Anxiety and Depression in Dry Eye Disease Patients According to Age Groups. Front Psychiatry 2022; 13:930714. [PMID: 35911246 PMCID: PMC9326042 DOI: 10.3389/fpsyt.2022.930714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate the association between dry eye disease (DED) and DED-related anxiety and depression tendencies, as well as the risk factors for anxiety and depression in patients with DED of different age groups. This was a cross-sectional study involving 160 patients with DED and 80 healthy individuals aged 20-65 years. All participants completed the investigation of the demographic characteristics, the Hospital Anxiety Depression Scale (HADS), the Ocular Surface Disease Index (OSDI) questionnaire, the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, and underwent objective clinical eye examinations. In patients aged 20-40 years, anxiety and depression scores were correlated with OSDI, sleep disorders, and Best Corrected Visual Acuity (BCVA). In patients with DED aged 41-65 years, anxiety scores were correlated with sleep disorders, the level of DED impact on life and work, and the severity of DED. Depression scores were correlated with sleep disorders and the severity of DED. The results indicated that the tendency for anxiety and depression was closely associated with DED and sleep disorders. Moreover, the factors affecting anxiety and depression in patients varied with age.
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Affiliation(s)
- Zhanglin Liu
- Tianjin Medical University Eye Hospital, Eye Institute and School of Optometry, Tianjin, China.,Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China.,Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
| | - Shengshu Sun
- Tianjin Medical University Eye Hospital, Eye Institute and School of Optometry, Tianjin, China.,Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China.,Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
| | - Xiaowen Sun
- Tianjin Medical University Eye Hospital, Eye Institute and School of Optometry, Tianjin, China.,Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China.,Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China.,Department of Ophthalmology, People's Hospital of Rizhao, Rizhao, China
| | - Yuan Wu
- Tianjin Medical University Eye Hospital, Eye Institute and School of Optometry, Tianjin, China.,Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China.,Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
| | - Yue Huang
- Tianjin Medical University Eye Hospital, Eye Institute and School of Optometry, Tianjin, China.,Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China.,Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
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10
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Provocation of dry eye disease symptoms during COVID-19 lockdown. Sci Rep 2021; 11:24434. [PMID: 34952901 PMCID: PMC8709849 DOI: 10.1038/s41598-021-03887-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/07/2021] [Indexed: 12/28/2022] Open
Abstract
To assess the impact of COVID-19 lockdown measures on dry-eye symptoms in a community-based population, a cross-sectional study was conducted during the first wave of the COVID-19 outbreak in Thailand. An online survey was distributed via social media between June and July 2020. The questionnaire elicited information on demographics, dry-eye symptoms, use of visual display terminals, and mental health status. There were 535 respondents. Thirty-seven percent reported having been diagnosed with dry-eye disease (DED). During the lockdown, the mean dry-eye symptom score (DESS) of overall participants dropped significantly from 81.6 ± 15.9 to 79.8 ± 17.4 (P < 0.001). The mean, daily, visual display terminal (VDT) usage increased from 10.55 ± 5.16 to 13.08 ± 5.65 h (P < 0.001). A negative correlation between age and VDT usage was observed in both the normal and lockdown situations. One-quarter of all participants had an abnormal mental health status. The female gender (OR 1.86; 95% CI 1.14–3.04) and increased VDT usage during the lockdown (OR 5.68; 95% CI 3.49–9.23) were independently associated with worsening dry-eye symptoms. The lockdown measures abruptly altered the behaviors and lifestyles of the overall population. Excessive exposure to VDTs were associated with deteriorated dry-eye symptoms, and it possibly contributed to the increased DED incidence in the surveyed population.
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11
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Basilious A, Xu CY, Malvankar-Mehta MS. Dry eye disease and psychiatric disorders: A systematic review and meta-analysis. Eur J Ophthalmol 2021; 32:1872-1889. [PMID: 34935549 PMCID: PMC9297048 DOI: 10.1177/11206721211060963] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The association between dry eye disease (DED) and psychiatric conditions is a highly researched topic. This work reviews the literature on this relationship, examining the prevalence and correlations of depression and anxiety with dry eye signs and symptoms. A comprehensive literature search of MEDLINE, EMBASE, PsycINFO, and gray literature was conducted, with keywords for dry eye and mood disorders, depression, anxiety, and suicide. Eligible studies underwent quality assessment using the Newcastle-Ottawa Scale. Meta-analysis was performed using STATA 15.0. Fixed- and random-effects models were computed based on the presence of heterogeneity. Thirty-two studies were included, with 31 reporting on depression and 19 on anxiety. Meta-analysis results found a depression prevalence of 40% (CI: [0.29, 0.52]) in DED patients, with 1.81 times higher odds of prevalence compared to controls (CI: [1.61, 2.02]). Prevalence of anxiety was 39% (CI: [0.15, 0.64]), with 2.32 times higher odds of prevalence compared to controls (CI: [1.67, 3.23]). Depression scores were significantly higher in patients with DED in all studies. Anxiety scores were significantly higher in DED patients in studies using all scales except the Hospital Anxiety and Depression Scale-Anxiety Subscale. DED symptom scores were significantly associated with depression (ES = 0.43; CI: [0.31, 0.55]) and anxiety (ES = 0.41; CI: [0.32, 0.50]) scores. In conclusion, depression and anxiety are more prevalent and severe in DED patients and are correlated with dry eye symptoms but not signs. These findings highlight the interrelationship between these disorders and have important implications for providing appropriate care to these patients.
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Affiliation(s)
- Amy Basilious
- 70384Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Cathy Y Xu
- 70384Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Monali S Malvankar-Mehta
- Department of Ophthalmology, 483166Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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12
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The effects of a steam warming eye mask on the ocular surface and mental health. Ocul Surf 2021; 21:129-133. [PMID: 34052414 DOI: 10.1016/j.jtos.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 02/10/2021] [Accepted: 05/22/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The continuous use of warming eye masks improves tear function. In this double-blind randomized controlled trial, we aimed to analyze the effects of warming eye mask use on the ocular surface and mental health. METHODS We enrolled 86 participants (age range: 23-89 years) from affiliated institutions who were divided into two groups: the warm group that used warming eye masks that generate moist heat at 40 °C for 10 min and the control group that used non-warming eye masks. The participants used the masks for 10 min once daily for 2 weeks. Before and after the intervention, in 79 participants (warm group 39, control group 40), we analyzed the tear break up time (TBUT) and corneal and conjunctival fluorescein staining results in the right eye and Hospital Anxiety and Depression Score (Anxiety: HADS-A, Depression: HADS-D), and Subjective Happiness Scale (SHS) questionnaires. The parameters before and after the intervention were compared via paired-t tests. RESULTS The following variables changed after the intervention: TBUT (warm group: 1.4 ± 2.1 s vs. control group: -0.01 ± 2.38 s), fluorescein staining score (-0.7 ± 1.1 vs.-0.2 ± 1.1), HADS-A (-0.8 ± 3.1 vs. -0.2 ± 2.2), and HADS-D (-1.0 ± 2.4 vs. -0.4 ± 1.9). Significant changes were observed in the TBUT (warm group), fluorescein staining score (warm group), and HADS-D (warm group). CONCLUSIONS Using a warming eye mask improves not only the ocular surface conditions but also the subjective depression scores.
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13
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Negishi K, Ayaki M, Kawashima M, Tsubota K. Sleep and subjective happiness between the ages 40 and 59 in relation to presbyopia and dry eye. PLoS One 2021; 16:e0250087. [PMID: 33891599 PMCID: PMC8064542 DOI: 10.1371/journal.pone.0250087] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of this study was to explore the status of quality of life between the ages 40–59 in relation to presbyopia and dry eye. Methods Near add power and preferred contact lens power were examined in 219 participants at three clinics. 2000 participants completed a web-based survey on presbyopic symptoms, symptomatic dry eye, sleep quality, and subjective happiness. Results Mean preferred corrected visual acuity was less than 20/20 in women (vs men, P<0.01) who were more often prescribed under-corrected contact lenses, whereas men preferred full correction. According to the annual progression rate of near add power in men (0.1468D/year), the estimated difference in presbyopia progression between men and women was 0.75 years in the right eye, and 1.69 years in the left eye, implying men might suffer presbyopia earlier than women due to higher myopic power of daily use contact lenses. The web-based survey revealed that men reported lower subjective happiness than women (P<0.001) and earlier onset of presbyopic symptoms by 1.1–1.7 years (P<0.05). Men received their first reading glasses 0.8 years earlier than women (P = 0.066). Multiple regression analysis demonstrated that awareness of presbyopic symptoms, visual burden, and dry eyes were significantly correlated with poor sleep quality and subjective happiness. Conclusion Presbyopia and dry eye were significantly associated with sleep quality and subjective happiness in middle-adulthood.
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Affiliation(s)
- Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- * E-mail: (MA); (KN)
| | - Masahiko Ayaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Otake Clinic Moon View Eye Center, Kanagawa, Japan
- * E-mail: (MA); (KN)
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Tsubota Laboratory, Inc., Tokyo, Japan
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14
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Feroze KB, AlAbdullah ZAM, AlOnayzan AHA, Pattath A. The association between personality traits and dry eye disease: A cross-sectional study. Saudi J Ophthalmol 2021; 34:120-123. [PMID: 33575534 PMCID: PMC7866725 DOI: 10.4103/1319-4534.305020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/19/2020] [Accepted: 06/05/2020] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Dry eye disease (DED) is a growing public health concern that causes significant visual disability and interferes with the quality of life. The aim of the study is to analyze the relationship between personality traits and DED symptoms in the eastern region of Saudi Arabia. METHODS A cross-sectional study was carried out in the Eastern Province of Saudi Arabia in 2018. A total of 613 subjects participated in this study. Ocular surface disease index was first distributed online to assess the subjective symptoms of DED. Then, persons with DED were selectively chosen to be tested by the Big Personality Trait Inventory questionnaire. Data were analyzed using one-way ANOVA test at a level of significance, P < 0.05. RESULTS 57.7% of the patients reported symptoms of DED. There was a significant positive correlation between DED and neuroticism personality trait. DED severity was found to be significantly correlated in persons with chronic diseases. CONCLUSION This study suggests that psychological problems have an impact on DEDs in a way that needed to be studied.
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Affiliation(s)
- Kaberi B Feroze
- Department of Ophthalmology, King Faisal University, College of Medicine, Faisal University, Al Al-Ahsa, Saudi Arabia
| | - Zahrah A M AlAbdullah
- Department of Ophthalmology, King Faisal University, College of Medicine, Faisal University, Al Al-Ahsa, Saudi Arabia
| | - Arwa H A AlOnayzan
- Department of Ophthalmology, King Faisal University, College of Medicine, Faisal University, Al Al-Ahsa, Saudi Arabia
| | - Abdulwahab Pattath
- Department of Neuroscience, King Faisal University, College of Medicine, Faisal University, Al Al-Ahsa, Saudi Arabia
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15
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Magno MS, Utheim TP, Snieder H, Hammond CJ, Vehof J. The relationship between dry eye and sleep quality. Ocul Surf 2021; 20:13-19. [PMID: 33421635 DOI: 10.1016/j.jtos.2020.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Sleep is an important determinant of health and quality of life. This study aimed to clarify the association between dry eye and sleep quality using a large population-based cohort. METHODS 71,761 participants (19-94 yrs, 59.4% female) from the Lifelines cohort in the Netherlands were assessed for dry eye using the Women's Health Study Dry Eye Questionnaire. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression was used to examine the relationship between poor sleep quality (PSQI score >5) and dry eye, while correcting for age, sex, BMI, education, income, and 51 possible confounding comorbidities, including autoimmune diseases and psychiatric disorders. RESULTS Overall, 8.9% of participants had dry eye. Of these, 36.4% had poor sleep quality compared to 24.8% of controls (OR 1.52 (95%CI 1.44-1.60), P < 0.0001, corrected for age and sex). After correcting for all comorbidities, dry eye was still associated with poor sleep (OR 1.20 (95%CI 1.11-1.28), P < 0.0001). This relationship was seen across all ages and sexes. Patients with dry eye scored worse on all subcomponents of the PSQI. Almost one-in-two (44.9%) persons with dry eye symptoms "often" or "constantly" had poor sleep quality. This proportion was similar to participants with sleep apnea and osteoarthritis. Additionally, increasing symptom frequency was tied to increased prevalence of poor sleep quality. CONCLUSIONS All components of sleep quality were significantly reduced in participants with dry eye, even after correcting for comorbidities. These results indicate the substantial impact of dry eye on patients' lives, especially for those with frequent symptoms.
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Affiliation(s)
- Morten Schjerven Magno
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway; Departments of Ophthalmology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Postbus 30.001, Groningen, the Netherlands
| | - Tor Paaske Utheim
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Postbus 30.001, Groningen, the Netherlands
| | - Christopher J Hammond
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital, Lambeth Palace Road, Waterloo, London, SE1 7EH, United Kingdom; Department of Ophthalmology, King's College London, St Thomas' Hospital, Westminster Bridge Road, Waterloo, London, SE1 7EH, United Kingdom
| | - Jelle Vehof
- Departments of Ophthalmology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Postbus 30.001, Groningen, the Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Postbus 30.001, Groningen, the Netherlands; Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital, Lambeth Palace Road, Waterloo, London, SE1 7EH, United Kingdom.
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16
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He Q, Chen Z, Xie C, Liu L, Wei R. The Association Between Dry Eye Disease With Depression, Anxiety and Sleep Disturbance During COVID-19. Front Psychiatry 2021; 12:802302. [PMID: 35069294 PMCID: PMC8766963 DOI: 10.3389/fpsyt.2021.802302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/13/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: This study aimed to investigate the relationship between dry eye disease (DED) with anxiety and depression. Additionally, the mediating effect of sleep quality on this relationship was explored. Methods: 321 patients with DED were recruited from Tianjin Medical University Eye Hospital clinic and surveyed using demographic questionnaires, the Ocular Surface Disease Index (OSDI), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI). Regression analysis and the bootstrap method were used to investigate the influence of sleep on the relationship between DED, anxiety and depression. Results: Among the patients with DED, 86 (26.79%), 85 (26.48%), and 54 (16.82%) patients presented with anxiety, depression, and both anxiety and depression respectively. The OSDI and PSQI score were positively correlated with depression and anxiety (all p < 0.01). The direct effects of OSDI on depression and anxiety were significant (P < 0.01). Additionally, the bootstrap test showed significant mediating effects of subjective sleep quality [95% CI [0.003-0.016] (depression); [0.001-0.011] (anxiety)] and sleep latency [95% CI [0.001-0.010] (depression); [0.001-0.008] (anxiety)]. These results indicated that the severity of DED symptoms, as measured by the OSDI score, affected anxiety and depression through a direct and an indirect pathway mediated by subjective sleep quality and sleep latency. Conclusions: The results indicated that there was a significant correlation between DED and anxiety and depression. Moreover, subjective sleep quality and sleep latency were a mediator of the relationship between DED symptoms and anxiety and depression.
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Affiliation(s)
- Qing He
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Zhuo Chen
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Caiyuan Xie
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Lin Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Ruihua Wei
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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17
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Kojima T, Dogru M, Kawashima M, Nakamura S, Tsubota K. Advances in the diagnosis and treatment of dry eye. Prog Retin Eye Res 2020; 78:100842. [PMID: 32004729 DOI: 10.1016/j.preteyeres.2020.100842] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/19/2020] [Accepted: 01/24/2020] [Indexed: 02/07/2023]
Abstract
The core mechanism of dry eye is the tear film instability. Tear film-oriented diagnosis (TFOD) is a concept to clarify the cause of tear film instability by tear film, and tear film-oriented treatment (TFOT) is a concept to treat dry eye disease by replacing the lacking components of the tear film layer based on the TFOD. In TFOD, the fluorescein breakup pattern of the tear film is important, and the subtype of dry eye can be judged to some extent from the breakup patterns. Current noninvasive devices related to the dynamic analysis of the tear film and visual acuity enabled the diagnosis of dry eye, subtype analysis, and the extent of severity. In Asian countries, secretagogues represent the main treatment in TFOT. Since meibomian gland dysfunction is a factor that greatly affects the tear breakup time, its treatment is also essential in the dry eye treatment strategy. A newly discovered dry eye subtype is the short breakup time-type (BUT) of dry eye. The only abnormal finding in this disease is the short BUT, suggesting a relationship with ocular neuropathic pain and eye strain. Recently, data from many studies have accumulated which show that dry eye is a life-style disease. In addition to the treatment of dry eyes, it is becoming possible to prevent the onset by intervening with the daily habits, diet, exercise and sleep, etc. It has been pointed out that oxidative stress is also involved in the pathology of dry eye, and intervention is being carried out by improving diet and taking supplements. Future research will be needed to link clinical findings to the molecular biological findings in the tear film.
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Affiliation(s)
- Takashi Kojima
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | - Murat Dogru
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | - Shigeru Nakamura
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Japan; Tsubota Laboratory, Inc., Tokyo, Japan.
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18
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Liu R, Zhao Y, Wu Y, Guo M, Duan Y, Ye J, Lu X. Individualized Chinese medicine for the treatment of diabetic patients with dry eye disease: A single-case randomized controlled protocol. Medicine (Baltimore) 2020; 99:e18459. [PMID: 31895776 PMCID: PMC6946556 DOI: 10.1097/md.0000000000018459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The high incidence of Diabetes mellitus (DM) has become a serious challenge for the global epidemic. Increased blood glucose leads to abnormal ocular surface structure and metabolic disorder in patients. DM is a high-risk factor for dry eye disease (DED), with high incidence and increased difficulty in treatment. The disease can cause discomfort, visual impairment, tear film instability and ocular surface damage, and even cause corneal erosion in severe cases, which has a serious impact on people's daily life. Traditional Chinese Medicine (TCM) plays an important role in the evaluation and treatment of DM and its complications. However, whether TCM treatment could improve the treatment efficacy of DM suffering from DED remains poorly understood. OBJECTIVE To investigate the curative effect of TCM for the alleviation of clinical symptoms in Diabetic patients with DED, and to evaluate its long-term efficacy. METHODS This trial is a single-case randomized, single-blind, placebo-controlled study. A total of 12 subjects will be recruited in this trial. The trial is divided into three cycles, and one cycle has 2 treatment periods. There is a washout period at each adjacent treatment stage. TCM individualized treatment and placebo will be randomized during the treatment period. The test period will last for 29 weeks, with 4 weeks for each treatment period and 1 week for each washout period to minimize carryover effects. Subjects will be selected by the researcher strictly in accordance with the inclusion and exclusion criteria. The outcomes will evaluate the efficacy of treatment by changes in the various observation indicators. DISCUSSION This study will realize a patient-centered outcome approach necessary to provide clinical researchers with the evidence that TCM treatment can effectively improve the objective indicators of the eye and systemic symptoms in Diabetic patients with DED. TRIAL REGISTRATION This study has been registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn, No. ChiCTR1900024481), (October, 2019).
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Affiliation(s)
- Ruibao Liu
- Chengdu University of Traditional Chinese Medicine, Academy of Ophthalmology
| | - Ying Zhao
- Chengdu University of Traditional Chinese Medicine, Academy of Ophthalmology
| | - Yanxia Wu
- Chengdu University of Traditional Chinese Medicine, Academy of Ophthalmology
| | - Minglu Guo
- Chengdu University of Traditional Chinese Medicine, Academy of Ophthalmology
| | - Yu Duan
- Chengdu University of Traditional Chinese Medicine, Academy of Ophthalmology
| | - Jianbin Ye
- Chengdu University of Traditional Chinese Medicine, Academy of Ophthalmology
| | - Xuejing Lu
- Chengdu University of Traditional Chinese Medicine, Academy of Ophthalmology
- Yinhai Eye Hospital affiliated to Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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19
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Yu X, Guo H, Liu X, Wang G, Min Y, Chen SHS, Han SS, Chang RT, Zhao X, Hsing A, Zhu S, Yao K. Dry eye and sleep quality: a large community-based study in Hangzhou. Sleep 2019; 42:5532656. [PMID: 31310315 DOI: 10.1093/sleep/zsz160] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/16/2019] [Indexed: 12/20/2022] Open
Abstract
Abstract
Study Objectives
To investigate the relationship between dry eye and sleep quality in a large community-based Chinese population.
Methods
A total of 3,070 participants aged 18–80 were recruited from a community-based study in Hangzhou, China during 2016–2017. Sleep quality was evaluated using the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), and dry eye was evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Multivariable linear regression and logistic regression models were used to investigate the associations, adjusting for age, smoking, drinking, season, and other potential confounders.
Results
Overall, CPSQI score and sleep dysfunction were significantly associated with mild, moderate, and severe dry eye (ORs for CPSQI score: 1.07, 1.13, 1.14, all p < 0.001; for sleep dysfunction: 1.31, 1.73, 1.66, all p < 0.05). Furthermore, worse OSDI score was presented in participants with worse CPSQI score or sleep dysfunction (CPSQI score > 7) (β: 0.13, 0.54; all p < 0.001). In addition, six of the seven components of CPSQI showed significant associations with dry eye (all p < 0.001), except for the component of sleep medication use. Moreover, we observed significant associations of dry eye in all three subscales of OSDI with CPSQI score and sleep dysfunction.
Conclusion
Our large, community-based study showed a strong association between poor sleep quality and an increased severity of dry eye, suggesting that preventing either one of the discomforts might alleviate the other.
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Affiliation(s)
- Xiaoning Yu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huilan Guo
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xin Liu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guowei Wang
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Min
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Shih-Hua Sarah Chen
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Summer S Han
- Department of Neurosurgery, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Robert T Chang
- Department of Ophthalmology, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Xueyin Zhao
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ann Hsing
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Shankuan Zhu
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ke Yao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Ayaki M, Tsubota K, Kawashima M, Kishimoto T, Mimura M, Negishi K. Sleep Disorders are a Prevalent and Serious Comorbidity in Dry Eye. Invest Ophthalmol Vis Sci 2019; 59:DES143-DES150. [PMID: 30481819 DOI: 10.1167/iovs.17-23467] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Sleep is an essential life habit and closely associated with lifespan, diabetes, hypertension, and mental health. Sleep disorders are a prominent, but overlooked problem in patients with dry eye disease (DED), characterized by a poor sleep index, short sleep duration, long sleep latency, and poor subjective sleep. DED and sleep disorders are more prevalent in women than men. Moreover, sleep quality in DED is worse than in other eye diseases, including glaucoma, retinal diseases, cataract, and allergic and chronic conjunctivitis. Methods We reviewed the literature for studies investigating sleep and health, eyes and sleep, and DED and sleep, in terms of systemic and eye health, especially in women. Results Two studies reported that approximately half of patients with DED suffer from poor sleep. The severity of mood disorders, including anxiety and depression, is correlated strongly with sleep disorders in DED, and the symptoms and signs of DED, especially pain, also are correlated with sleep quality. Sleep disorders are documented in primary Sjögren's syndrome and an association with sleep apnea and depression is suggested. Primary Sjögren's syndrome includes arthritis and other rheumatic disease causing pain and fatigue; however, how sicca contributes to sleep disorders is not known. Conclusions Possible explanations for sleep disorders in DED may be depression, pain, and eye exposure at night. Reciprocal effects may be expected and consultation-liaison psychiatry is recommended for the management of sleep disorders in DED. Topical medication and lid heating also may be advantageous for sleep quality in DED.
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Affiliation(s)
- Masahiko Ayaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.,Otake Clinic Moon View Eye Center, Yamato, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Taishiro Kishimoto
- Department of Psychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Psychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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21
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Lim EWL, Chee ML, Sabanayagam C, Majithia S, Tao Y, Wong TY, Cheng CY, Tong L. Relationship Between Sleep and Symptoms of Tear Dysfunction in Singapore Malays and Indians. ACTA ACUST UNITED AC 2019; 60:1889-1897. [DOI: 10.1167/iovs.19-26810] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Miao Li Chee
- Singapore Eye Research Institute, Singapore, Singapore
| | | | | | - Yijin Tao
- Singapore Eye Research Institute, Singapore, Singapore
| | - Tien Yin Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Ching-Yu Cheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Louis Tong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
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22
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Sano K, Kawashima M, Imada T, Suzuki T, Nakamura S, Mimura M, Tanaka KF, Tsubota K. Enriched environment alleviates stress-induced dry-eye through the BDNF axis. Sci Rep 2019; 9:3422. [PMID: 30833600 PMCID: PMC6399317 DOI: 10.1038/s41598-019-39467-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/24/2019] [Indexed: 01/20/2023] Open
Abstract
The number of patients with dry eye disease (DED) is increasing, and DED has become an urgent public health problem. A comorbidity of mental disorders has been reported in DED patients. We hypothesized that physical and psychological stressors impair tear secretion. To examine the relationship between stress loading and decreased tear secretion, we established a stress-induced DED mouse model, which permitted us to address the underlying mechanism of pathogenesis and resilience. Enriched environment (EE) was an effective intervention to prevent and alleviate stress-induced decreased tear secretion. Because stress loading resulted in decreased brain-derived neurotrophic factor (BDNF) expression while EE resulted in increased expression, we focused on the role of BDNF in tear secretion. Using two distinct Bdnf gene knockdown mice, we evaluated whether BDNF was a deterministic factor in regulating tear secretion in healthy and stressed conditions. Bdnf knockdown mice showed decreased basal tear secretion and loss of stress tolerance by EE for tear secretion. These results suggest that BDNF expression is related to tear secretion and to the pathology of DED.
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Affiliation(s)
- Kokoro Sano
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Toshihiro Imada
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Toru Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Shigeru Nakamura
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Kenji F Tanaka
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, 160-8582, Japan.
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, 160-8582, Japan.
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Association Between Sleep Quality, Mood Status, and Ocular Surface Characteristics in Patients With Dry Eye Disease. Cornea 2019; 38:311-317. [PMID: 30614900 DOI: 10.1097/ico.0000000000001854] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate sleep and mood status in patients with dry eye disease (DED) and analyze the association between sleep quality, mood status, and ocular surface characteristics. METHODS Consecutive patients with DED (N = 106) and age- and sex-matched healthy controls (N = 50) were enrolled. Tear fluid break up time (TBUT), corneal fluorescein staining, and Schirmer I tests were performed in the order listed here to evaluate dry eye. A visual analog scale was used to assess dry eye symptom severity. All subjects also completed the Pittsburgh Sleep Quality Index (PSQI, scores ≥5.5 indicated poor sleep), Patient Health Questionnaire (scores ≥5 indicated depression), and General Anxiety Disorder Scale (scores ≥5 indicated anxiety). RESULTS Mean Pittsburgh Sleep Quality Index global score was significantly higher in patients with DED than that in controls (7.8 ± 3.9 vs. 5.4 ± 3.0, respectively; P < 0.001). Patients with DED demonstrated higher respective depression and anxiety scores compared with controls (P < 0.001 and 0.013, respectively). In the DED group, patients with poor sleep quality had more severe DED indicated by shorter TBUT and lower Schirmer I findings. A significant correlation was found between sleep quality and mood status in patients with DED. Regression analysis revealed that shorter TBUT and lower Schirmer I test results were associated with poorer sleep quality (adjusted p = 0.011 and 0.037, respectively). More severe symptoms of dry eye were significantly associated with a higher level of anxiety in patients with DED (adjusted p = 0.011). CONCLUSIONS Sleep quality may play an important role in the development of DED by influencing tear secretion and tear film stability and/or by indirectly aggravating anxiety and depression, leading to higher self-reported symptom scores. It is also possible that DED contributes to reduced sleep quality, as well as the development of anxiety and depression.
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Dana R, Bradley JL, Guerin A, Pivneva I, Evans AM, Stillman IÖ. Comorbidities and Prescribed Medications in Patients With or Without Dry Eye Disease: A Population-Based Study. Am J Ophthalmol 2019; 198:181-192. [PMID: 30312577 DOI: 10.1016/j.ajo.2018.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the proportion of comorbidities in patients with dry eye disease (DED) compared with matched patients without DED in a comprehensive US population. DESIGN Retrospective case-control study. METHODS Healthcare records for insurance claims data, detailing medical services incurred by military personnel and their families and dependents in military and civilian facilities across the United States from January 1, 2003, to March 31, 2015, were obtained from the Department of Defense (DOD) Military Health System (MHS). Diagnostic and procedural codes related to DED from selected International Classification of Diseases, Ninth Revision (ICD-9) Current Procedural Terminology codes and prescriptions for cyclosporine A ophthalmic emulsion were used to identify patients with newly diagnosed and prevalent DED in the MHS database. Age, sex, and geographically matched patients without DED were also identified from healthcare claims records. Medication use and comorbidities in these patient populations were assessed and compared. RESULTS In both the newly diagnosed and prevalent DED samples, the most common comorbidities were hypertension, cataracts, thyroid disease, type 2 diabetes, and glaucoma. All comorbidities were significantly higher in the DED vs non-DED groups (P < .001). Medication use (including, but not limited to, ophthalmic agents and drugs to treat comorbidities) was also significantly higher in the DED than in the non-DED groups (P < .001). CONCLUSIONS The high proportions of patients with DED with a range of comorbidities and prescribed medications highlight the need for a multidisciplinary approach to the management of these patients.
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Affiliation(s)
- Reza Dana
- Harvard Medical School, Boston, Massachusetts, USA; Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - John L Bradley
- Naval Medical Research Unit Dayton, Wright-Patterson Air Force Base, Ohio, USA; Kentucky College of Optometry, University of Pikeville, Pikeville, Kentucky, USA
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Matossian C, McDonald M, Donaldson KE, Nichols KK, MacIver S, Gupta PK. Dry Eye Disease: Consideration for Women's Health. J Womens Health (Larchmt) 2019; 28:502-514. [PMID: 30694724 PMCID: PMC6482917 DOI: 10.1089/jwh.2018.7041] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Dry eye disease (DED) is a multifactorial disorder of the ocular surface and tear homeostasis that can result in discomfort, pain, and visual disturbance. Untreated, DED can become chronic, progressive, and significantly affect an individual's quality of life. Women are disproportionately affected by DED, are diagnosed at a younger age, and experience more severe symptoms compared with men. DED is associated with a wide range of comorbid conditions; there is a strong association between DED and autoimmune disorders, especially those that affect women at many times the rate of men. Treatment response questionnaires indicate women respond better to a wellness model of treatment for DED than men. Furthermore, women's health care-seeking behaviors provide opportunities for general practitioners, specialists, and women's health centers to help identify women with DED or at risk for DED for referral to an eye care specialist. This review of the prevalence of DED in women, and gender and sex-specific aspects of DED, highlight a significant opportunity for action. Earlier diagnosis and treatment of this common but burdensome condition could significantly improve a woman's quality of life.
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Affiliation(s)
| | | | - Kendall E Donaldson
- 3 Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Kelly K Nichols
- 4 School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sarah MacIver
- 5 School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - Preeya K Gupta
- 6 Division of Cornea and Refractive Surgery, Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
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Zou X, Lu L, Xu Y, Zhu J, He J, Zhang B, Zou H. Prevalence and clinical characteristics of dry eye disease in community-based type 2 diabetic patients: the Beixinjing eye study. BMC Ophthalmol 2018; 18:117. [PMID: 29747621 PMCID: PMC5946388 DOI: 10.1186/s12886-018-0781-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 04/30/2018] [Indexed: 02/07/2023] Open
Abstract
Background This study was performed to evaluate the prevalence and clinical characteristics of dry eye disease (DED) in community-based type 2 diabetic patients and to identify the associated factors related with DED. Methods A total of 1360 type 2 diabetic patients in the Beixinjing community were randomly selected. All participants were given a questionnaire that assessed basic information and subjective symptoms.DED was diagnosed using the revised Japanese DED diagnostic criteria. All subjects underwent a routine ophthalmic examination, corneal sensitivity test, tear film break-up time(BUT) test, Schirmer I test, fluorescein and lissamine green staining(FL) and fundus photography. Diabetic retinopathy (DR) was graded according to the International severity scale of diabetic retinopathy and diabetic macular edema. Results Of the 1360 subjects, 238 (17.5%) were diagnosed with DED. There was a significant association between the presence of DED and higher blood glucose (P < 0.001, OR1.240) as well as higher levels of glycosylated hemoglobin HbA1c (P < 0.001, OR1.108). Corneal sensitivity was negatively correlated with the prevalence of DED (P = 0.02, OR0.973). Conclusions The prevalence of DED in this community-based study was 17.5%, which was lower than that observed in hospital-based studies. Diabetic patients with poor metabolic control were more likely to present with DED. A dry eye examination should be added to the routine screening of diabetes.
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Affiliation(s)
- Xinrong Zou
- Shanghai General Hospital, Nanjing Medical University, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China.,Department of Ophthalmology, Fengcheng Hospital, No.9983, Chuannanfeng Road, Fengxian District, Shanghai, 201411, China
| | - Lina Lu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, No. 380, Kangding Road, Jingan, Shanghai, 200040, China
| | - Yi Xu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, No. 380, Kangding Road, Jingan, Shanghai, 200040, China
| | - Jianfeng Zhu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, No. 380, Kangding Road, Jingan, Shanghai, 200040, China
| | - Jiangnan He
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, No. 380, Kangding Road, Jingan, Shanghai, 200040, China
| | - Bo Zhang
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, No. 380, Kangding Road, Jingan, Shanghai, 200040, China
| | - Haidong Zou
- Shanghai General Hospital, Nanjing Medical University, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China. .,Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, No. 380, Kangding Road, Jingan, Shanghai, 200040, China. .,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China. .,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.
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Dry eye, sleep quality, and mood status in glaucoma patients receiving prostaglandin monotherapy were comparable with those in non-glaucoma subjects. PLoS One 2017; 12:e0188534. [PMID: 29176799 PMCID: PMC5703517 DOI: 10.1371/journal.pone.0188534] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/08/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose Prior studies suggested that glaucoma patients suffer worse dry eye and mood and sleep disorders than non-glaucoma subjects. Prostaglandin analogues are first-line therapy for glaucoma, inducing few instillation problems and sufficient pressure-reduction effects. This study compared dry eye, sleep quality, and mood status between glaucoma patients receiving prostaglandin monotherapy and non-glaucoma subjects. Methods This cross-sectional study evaluated 1520 patients (579 males and 941 females) for glaucoma status and dry eye-related symptoms (dryness, eye fatigue, photophobia, pain, blurring) and signs (Schirmer test, tear break-up time, corneal staining scores). Of the total cohort, 93 patients were also evaluated by Pittsburgh sleep quality index (PSQI) and hospital anxiety and depression score (HADS). Inclusion criteria were consecutive patients ≥ 51 years of age and best-corrected visual acuity ≥ 20/25. Glaucoma patients included those treated with prostaglandin or a fixed combination including prostaglandin. Exclusion criteria were history of ocular surgery within one month. Data were analyzed using the chi-square or Mann-Whitney U tests, at 5% significance. Results There were no significant differences in dry eye-related signs and symptoms between the control (n = 1431, mean age of 66.9 years) and glaucoma groups (n = 89, 67.9 years). The psychiatric sub-analysis of the control (n = 61, 66.2 years) and glaucoma groups (n = 32, 67.3 years) revealed mean scores of 5.02 ± 3.10 and 5.16 ± 3.46 for PSQI (normal range ≤ 5), 9.47 ± 5.61 and 9.42 ± 7.36 for HADS (normal range ≤ 10), 4.84 ± 3.22 and 4.71 ± 3.45 for anxiety (normal range ≤ 5), and 4.63 ± 3.05 and 4.71 ± 4.40 for depression (normal range ≤ 5), respectively, without statistical significance. Conclusions Our results were comparable between glaucoma patients on prostaglandin monotherapy and non-glaucoma subjects for dry eye-related clinical manifestations, sleep quality, and mood status.
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