TY - JOUR
T1 - Longitudinal examination of frequency of and risk factors for severe dry eye symptoms in us veterans
AU - Ong, Erin S.
AU - Alghamdi, Yousef A.
AU - Levitt, Roy C.
AU - McClellan, Allison L.
AU - Lewis, Gail
AU - Sarantopoulos, Constantine D.
AU - Felix, Elizabeth R.
AU - Galor, Anat
N1 - Funding Information:
This study was supported by grant EPID-006-15S from the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research (Dr Galor), Center Core Grant P30EY014801 from the National Institutes of Health, and an unrestricted grant from Research to Prevent Blindness.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - IMPORTANCE Dry eye syndrome is a common condition that affects millions of individuals. Many cross-sectional studies have evaluated risk factors for dry eye severity, but few have assessed risk factors or symptom progression over time. OBJECTIVES To assess symptom progression in dry eye syndrome and determine risk factors associated with severe symptoms at 1 year. DESIGN, SETTING, AND PARTICIPANTS A longitudinal studywas conducted from October 1, 2013, to April 30, 2015, among patients at the Miami Veterans Affairs Hospital with a wide variety of dry eye symptoms and signs (ranging from none to severe). MAIN OUTCOMES AND MEASURES Change in dry eye symptom severity during 1 year, as assessed by responses to dry eye symptom questionnaires administered at the initial visit and 1 year later, as well as baseline risk factor analysis for severe dry eye symptoms at 1 year, defined as a Dry Eye Questionnaire 5 score of 12 or more. RESULTS Of the 120 patients (mean [SD] age, 64 [11] years; 109 male and 11 female), 26 of 58 (44.8%) with either no symptoms or mild or moderate symptoms at baseline progressed to more severe symptoms at 1 year, while 46 of 62 patients (74.2%) with severe symptoms at baseline reported that severe symptoms persisted at 1 year. Baseline ocular risk factors for severe dry eye symptoms at 1 year included more severe dry eye symptoms, ocular pain, and neuropathic pain-like ocular symptoms. Nonocular risk factors included sleep disturbances (eg, sleep apnea and insomnia), mental health status (eg, posttraumatic stress disorder and depression), nonocular pain, and medications (eg, anxiolytics and analgesics). In a multivariable analysis, the most significant risk factors were sleep apnea (odds ratio [OR], 3.80; 95%CI, 1.00-14.49; P = .05), Dry Eye Questionnaire 5 score (OR, 1.15; 95%CI, 1.02-1.30; P = .02), and posttraumatic stress disorder score (OR, 1.04; 95%CI, 1.01-1.08; P = .02). CONCLUSIONS AND RELEVANCE Patients with severe dry eye symptoms and ocular pain at baseline were more likely to have persistent severe dry eye symptoms on 1-year follow-up. Furthermore, nonocular risk factors that have been associated with dry eye cross-sectionally, such as psychiatric comorbidities and nonocular pain, were also associated with severe dry eye symptoms at 1 year. Although this cohort was limited to US veterans, which may not be generalizable to other populations, our results suggest that pain perception and severity are important when evaluating and managing dry eye.
AB - IMPORTANCE Dry eye syndrome is a common condition that affects millions of individuals. Many cross-sectional studies have evaluated risk factors for dry eye severity, but few have assessed risk factors or symptom progression over time. OBJECTIVES To assess symptom progression in dry eye syndrome and determine risk factors associated with severe symptoms at 1 year. DESIGN, SETTING, AND PARTICIPANTS A longitudinal studywas conducted from October 1, 2013, to April 30, 2015, among patients at the Miami Veterans Affairs Hospital with a wide variety of dry eye symptoms and signs (ranging from none to severe). MAIN OUTCOMES AND MEASURES Change in dry eye symptom severity during 1 year, as assessed by responses to dry eye symptom questionnaires administered at the initial visit and 1 year later, as well as baseline risk factor analysis for severe dry eye symptoms at 1 year, defined as a Dry Eye Questionnaire 5 score of 12 or more. RESULTS Of the 120 patients (mean [SD] age, 64 [11] years; 109 male and 11 female), 26 of 58 (44.8%) with either no symptoms or mild or moderate symptoms at baseline progressed to more severe symptoms at 1 year, while 46 of 62 patients (74.2%) with severe symptoms at baseline reported that severe symptoms persisted at 1 year. Baseline ocular risk factors for severe dry eye symptoms at 1 year included more severe dry eye symptoms, ocular pain, and neuropathic pain-like ocular symptoms. Nonocular risk factors included sleep disturbances (eg, sleep apnea and insomnia), mental health status (eg, posttraumatic stress disorder and depression), nonocular pain, and medications (eg, anxiolytics and analgesics). In a multivariable analysis, the most significant risk factors were sleep apnea (odds ratio [OR], 3.80; 95%CI, 1.00-14.49; P = .05), Dry Eye Questionnaire 5 score (OR, 1.15; 95%CI, 1.02-1.30; P = .02), and posttraumatic stress disorder score (OR, 1.04; 95%CI, 1.01-1.08; P = .02). CONCLUSIONS AND RELEVANCE Patients with severe dry eye symptoms and ocular pain at baseline were more likely to have persistent severe dry eye symptoms on 1-year follow-up. Furthermore, nonocular risk factors that have been associated with dry eye cross-sectionally, such as psychiatric comorbidities and nonocular pain, were also associated with severe dry eye symptoms at 1 year. Although this cohort was limited to US veterans, which may not be generalizable to other populations, our results suggest that pain perception and severity are important when evaluating and managing dry eye.
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U2 - 10.1001/jamaophthalmol.2016.4925
DO - 10.1001/jamaophthalmol.2016.4925
M3 - Article
C2 - 28006039
AN - SCOPUS:85014541157
VL - 135
SP - 116
EP - 123
JO - JAMA Ophthalmology
JF - JAMA Ophthalmology
SN - 2168-6165
IS - 2
ER -