Dry eye disease (DED) is a highly prevalent syndrome that manifests with symptoms that include constant irritation, burning or stinging sensations, and feelings of grittiness in the eyes. “DED is a chronic pain syndrome often associated with variable vision,” says Penny A. Asbell, MD, FACS, MBA, from the University of Tennessee Health Science Center. “However, DED is often overlooked by healthcare providers because it does not cause blindness and because treatment can be challenging.”
The intensity of dry eye symptoms is typically used as a measure of DED severity and can be determined using the Ocular Surface Discomfort Index (OSDI), a 12-items questionnaire, explains Giampaolo Greco, PhD, from the Icahn School of Medicine at Mount Sinai. “The ODSI provides a score for the severity of DED, which ranges from 1 to 100, with higher values indicating worse severity,” he says. “Other clinical tests can also be used to confirm a DED diagnosis using quantitative score measures. These include conjunctival staining, corneal staining, tear break up time after blinking, and the Schirmer test.”
At the 2020 American Academy of Ophthalmology Annual Meeting, Dr. Greco and a team of investigators presented data evaluating the association of DED severity with work productivity and activity impairment using the OSDI as well as other objective clinical tests of DED signs. The longitudinal observational analysis included 535 patients with moderate to severe DED who were previously enrolled in the DREAM study. Participants were surveyed with the Work Productivity and Activity Impairment questionnaire at 0, 6, and 12 months. Co-authors on the study included Dr. Asbell; Maureen G. Maguire, PhD, MD, FACS; and Maxwell Pistilli, MS. Dr. Greco noted that previous studies were designed to capture only a cross-sectional association between DED and work impairment.
“Our primary objective was to determine if DED interfered with work and non-work activities,” Dr. Greco says. “While previous studies have reported decreased work productivity in patients with DED, our study was different in that it included patients with varying levels of dry eye severity and assessed participants using a variety of clinical tests beyond the OSDI over the course of 1 year. We also controlled for the potential confounding effect of several risk factors, including highly prevalent chronic conditions like diabetes, depression, and arthritis, all of which might also impact work productivity.”
According to the results, patients with higher OSDI scores had higher rates of absenteeism, presenteeism, and activity impairment. “We found that impairment increased with worsening DED symptoms,” Dr. Greco says. “In addition, patients whose symptoms worsened over time were more likely to have increased impairment, even after accounting for comorbidities. To our knowledge, this is the first study showing that changes in DED severity over time are associated with corresponding changes in work-productivity.” Dr. Asbell, who was the chair of the DREAM study, adds, “this research on work productivity and dry eye offers yet another reason to address dry eye care with serious deliberation.”
Dr. Maguire, a co-author of the study from the Perelman School of Medicine at the University of Pennsylvania, says “there are many remedies available to relieve symptoms for patients with dry eyes, ranging from artificial tears to prescription drugs and devices to improve Meibomian gland function. Many of these therapies can provide relief for some patients with DED, but others may still suffer from symptoms. Unfortunately, many patients will need to try a few treatment options before finding one that works. Our data indicate that relieving DED symptoms may reduce work impairments in productivity and non-work activity. The findings from our study should encourage all ophthalmic care providers to be persistent in seeking relief from symptoms for their patients. DED is more than a minor bother to patients—it can have a real impact on patients’ lives.”
Asbell PA, et al. Work Productivity in the Dry Eye Assessment and Management (DREAM) Study in Association With Signs and Symptoms of Dry Eye. Presented at: American Academy of Ophthalmology 2020 Virtual Congress. Session: PO102. November 2020. Available at: https://aaommg.apprisor.org/apsSession.cfm?id=PO102.
Greco G, Pistili M, Asbell PA, Maguire MG; Dry Eye Assessment and Management (DREAM) Study Research Group. Association of severity of dry eye disease with work productivity and activity impairment in the dry eye assessment & management study. Ophthalmology. 2020;S0161-6420(20):31014-31019. Available at: https://www.aaojournal.org/article/S0161-6420(20)31014-9/fulltext.
Dry Eye Assessment and Management Study Research Group; Asbell PA, Maguire MG, Pistilli M, et al. n-3 fatty acid supplementation for the treatment of dry eye disease. N Engl J Med. 2018;378(18):1681-1690. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952353/.
Asbell PA, Maguire MG, Peskin E, Bunva VY, Kuklinski EJ, for The Dry Eye Assessment and Management (DREAM) Study Research Group. Dry Eye Assessment and Management (DREAM) Study: Study design and baseline characteristics. Contemp Clin Trials. 2018;71:70-79. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7250048/.