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Groundbreaking Study Highlights Quality-of-Life Impact of Dry Eye Disease
A new study published in The Ocular Surface journal has provided crucial insights into the significant burden that dry eye disease (DED) places on individuals’ quality of life. Utilising real-world data from the international Save Sight Dry Eye Registry, researchers identified a pressing need for personalised treatment approaches to manage the disease better.
The global research team, comprising ophthalmologists, optometrists, and dry eye specialists from Australia, New Zealand, the United Kingdom, Spain, France, Germany, and Nepal, uncovered key findings that could reshape the clinical management of DED. The study’s use of advanced psychometric methods revealed that individuals with mixed subtype DED (a combination of evaporative and aqueous-deficient DED), corneal neuropathic pain, a history of DED treatment, or past DED-related procedures experience significantly worse symptoms, greater activity limitations, and reduced overall quality of life.
"We used Rasch analysis, a modern psychometric method, to refine commonly used dry eye assessment tools and generate reliable Quality of life data," said Dr Himal Kandel from The University of Sydney, the lead author of the study. "Our results highlight that DED is more than just a clinical condition—it significantly affects mental health, daily activities, and overall well-being." said Dr Kandel.
Key Findings of the Study:
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Gender and DED: While women are diagnosed with DED more frequently than men, the study found that once diagnosed, the quality-of-life impact was similar across genders.
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Impact of DED Subtypes: Patients with mixed subtype DED reported worse quality-of-life outcomes than those with only evaporative or aqueous-deficient DED, suggesting it may represent a more advanced stage of the disease.
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Correlation Between Signs and Symptoms: Clinical signs of DED did not consistently correlate with patient-reported symptoms. Some patients with mild signs reported severe symptoms, while others with severe clinical indicators experienced minimal discomfort. This underscores the importance of independent assessment of both clinical signs and patient experiences in treatment planning.
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Mental Health Impacts: Anxiety-related concerns were more prevalent among DED patients than depression. The findings suggest that psychological support could be beneficial for some patients, as DED symptoms played a more significant role in mental health outcomes than clinical signs, visual acuity, or age.
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Visual Acuity and Functional Vision: Worse visual acuity was linked to greater activity limitations. However, it did not correlate with traditional clinical test scores such as tear break-up time or corneal staining. Alternative assessments like spatial contrast sensitivity and reading speed may provide a more accurate measure of DED’s visual impact.
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Corneal Neuropathic Pain: Patients with corneal neuropathic pain reported worse symptoms, greater activity limitations, and poorer mental health than those without neuropathic pain.
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Patient-Reported Outcome Measures: The Ocular Surface Disease Index (OSDI), a widely used DED questionnaire, may require validation with modern psychometric methods to ensure accurate assessment of quality-of-life impacts.
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Challenges in Improving Quality of Life: The study highlighted the difficulties in fully restoring quality of life for patients with severe or chronic DED, especially those who have undergone multiple treatments or procedures. While current therapies may offer relief, they may not fully reverse the disease’s impact on daily life.
“These findings reinforce the need for a holistic approach to DED management,” said Professor Fiona Stapleton AO from UNSW School of Optometry and Vision Science. “A comprehensive assessment that includes both signs and symptoms is critical to ensure optimal patient care.”
Professor Stephanie L Watson OAM, the senior author of the paper and the Chief Investigator of the Save Sight Dry Eye Registry project, emphasised the significance of this research in advancing real-world evidence on DED. “This study from the international registry has established its role in benchmarking clinical practice and guiding future research. Longitudinal studies using SSDER will further enhance our understanding of treatment effectiveness and patient-centred outcomes.”
“As DED continues to be a significant public health concern, studies like this pave the way for more effective, evidence-based management strategies that prioritise patient well-being and quality of life improvement”, added Prof Watson OAM.
The full open-access article is available here: https://doi.org/10.1016/j.jtos.2025.02.005
