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Original Investigation
February 2017

Longitudinal Examination of Frequency of and Risk Factors for Severe Dry Eye Symptoms in US Veterans

Author Affiliations
  • 1Ophthalmology Department, Bruce W. Carter Department of Veteran Affairs, Miami Veterans Administration Medical Center, Miami, Florida
  • 2Bascom Palmer Eye Institute, University of Miami, Miami, Florida
  • 3John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida
  • 4Department of Anesthesiology, Perioperative Medicine, and Pain Management, Miller School of Medicine, University of Miami, Miami, Florida
  • 5John T. Macdonald Foundation Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida
  • 6Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, Florida
JAMA Ophthalmol. 2017;135(2):116-123. doi:10.1001/jamaophthalmol.2016.4925
Key Points

Questions  What are the nature of symptom progression in dry eye and the risk factors associated with severe symptoms at 1 year?

Findings  In this longitudinal study of US veterans, most patients with severe baseline dry eye symptoms reported persistent severe symptoms at 1 year. Baseline nociceptive and neuropathic ocular pain, in addition to sleep disturbances, mental health status, nonocular pain, and medications were also risk factors.

Meaning  These findings suggest that severe dry eye symptoms, baseline ocular pain, and nonocular risk factors that affect pain perception and severity are associated with severe dry eye symptoms 1 year after initial evaluation.

Abstract

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 study was 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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