Dry Eye Disease: The Humanistic, Psychological, and Economic Impact

Figure 1. Effect of Dry Eye Disease on Daily Activities and Physical Health4-8  

Figure 2. Effect of Dry Eye Disease on Psychological Health5,14,18  

The condition’s effect on these areas should act as an additional call to action for prompt diagnosis and treatment 

By Queresh Maskati, MD, Sonia Kothari, MD, Anjana Parameswaran, MD, 
& Arindam Dey, MD
 Globally, the prevalence of dry eye disease (DED) is estimated between 5% and 50%1 While ophthalmologists are well aware of the ocular health implications of the condition, they may not be aware of the humanistic, psychological, and economic impact of dry eye disease — all additional reasons DED should be considered a priority among other important diagnoses in the ophthalmologist’s practice. 
            Here, we discuss the disease’s impact in these areas. 

Humanistic Burden
The chronic symptoms of DED, such as ocular pain, altered ocular sensation, blurry vision, and ocular discomfort negatively impact the overall health-related quality of life (HR-QoL) in patients.2,3 Blurry vision, for example, restricts and adversely affects several daily activities 4,5 (Figure 1), whereas fluctuating vision can lead to low participation in recreational/leisure activities.5 
            Additionally, sleep disorders are common in DED, and are characterized by sleep deprivation, poor quality of sleep, greater daytime sleepiness, and sleep disturbances resulting in reduced happiness and well-being.6-10 About 42% to 45% of patients report impact of DED on sleep as compared to other eye diseases (34% to 39%).9
            Something else to keep in mind: Compromised QoL in DED is shown to be similar or comparable to that of other ocular conditions, such as age-related macular degeneration, retinal detachment, and allergic conjunctivitis.11 Also, the impact of severe DED could be commensurate with chronic systemic or physical disorders, rheumatoid arthritis, chronic obstructive pulmonary disease, and class III/IV angina.12,13 
Psychological Effects
            DED is associated with several psychological disorders, including depression, stress, poor self-perception, and anxiety.14,15 (Figure 2) Recent studies have demonstrated a significant positive correlation between DED symptoms (not the signs) and depression and anxiety.16,17 Further, approximately 29% of DED patients report symptoms of depression, the highest among other eye disorders.18
Economic Burden
            The chronic condition is also associated with high economic costs, both directly and indirectly, that increase with the severity of the disease.19 
            Direct cost refers to the cost of care, such as medical fees for the doctors’ visit, prescribed or over-the-counter drugs, related nutritional supplies, and cash pay in-office dry eye treatments. 
            Indirect cost refers to the cost incurred from low employment, absence from work, and impaired productivity at work.19-21 A recent systematic review pointed out that the indirect costs (owing to loss of productivity) contributed the highest to the overall cost for a DED patient.21,22
            Also, DED is shown to be negatively associated with several work productivity measures, such as the work productivity index, activity Index, and absenteeism.23,24 
Wanted: Dry Eye Specialists 
As illustrated above, the humanistic, psychological, and economic impact of DED are other reasons the chronic condition should be kept on the ophthalmologist’s diagnostic radar. Ophthalmologists can make a difference in the area of ocular health specifically, DED through elaborate medical history and assessing the impact on QOL using common Questionnaires, like Impact of Dry Eye on Everyday Life (IDEEL)/Ocular Surface Disease Index (OSDI). Clinicians should also emphasize compliance with long-term management, and a collaborative approach is needed to raise awareness of DED’s impact on the QOL of patients. CP
Cynthia Matossian, MD, FACS, reviewed this article.
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Dr. Quresh Maskati M.S. & D.O.M.S & F.C.P.S. is director, Cornea Service, Maskati Eye Clinic, Mumbai, Maharashtra, India. 

Dr. Sonia Kothari, MBBS, DO, DNB, Cornea Fellowship (LVPEI), is a consultant at Cornea and Anterior Segment, Bombay City Eye Institute & Research Centre.

Dr. Anjana Parameswaran, MD MSc (Clinical Drug Development) is a medical advisor for Alcon Laboratories India Pvt. Ltd., Bangalore, Karnataka, India.

Dr. Arindam Dey, MD MBA is the head-India and South-East Asia Medical Affairs for Alcon Laboratories India Pvt. Ltd., Bangalore, Karnataka, India.