Objective
The goal of this study is to describe the natural history of Dry Eye Disease (DED), which chronically affects millions of people in the US alone.
Design
This study includes cohorts from the Women's Health Study (WHS) and Physicians' Health Studies (PHS), and utilizes a combination of cross-sectional surveys and review of existing medical records.
Participants
398 men from the PHS and 386 women from the WHS who reported they had DED and responded to a questionnaire about change in various aspects of the disease since initial diagnosis.
Methods
Three subscales were developed based on factor analysis of questionnaire responses: ocular surface symptoms, vision-related symptoms, and social impact. We examined correlates of patient-reported worsening on each subscale. We also obtained medical records from a subset of 261 study participants, and examined changes in clinical signs of DED over time.
Main Outcome Measures
Ocular surface symptoms, vision-related symptoms, and social impact plus presence/absence of various clinical signs in patients' medical charts.
Results
Participants reported an average duration of DED of 10.5 years (SD 9.5 years). Worsening was reported by 24% for ocular surface symptoms, 29% for vision-related symptoms, and 10% for social impact. Factors associated with worsening on at least 2 of 3 subscales included a previous report of severe DED symptoms (OR=2.17 for ocular surface symptoms; OR=2.35 for vision-related symptoms), spending >$20 a month on DED treatments (OR=1.80 for ocular surface symptoms; OR=1.99 for vision-related symptoms), history of blepharitis or meibomian gland dysfunction (MGD) (OR=1.57 for vision-related symptoms; OR=2.12 for social impact) and use of systemic beta-blockers (OR=1.62 for ocular surface symptoms; OR=1.84 for vision-related symptoms, and OR=1.86 for the social impact of DED). Presence of corneal staining based on review of medical records was associated with use of level 2 or higher DED treatments (OR=1.54, CI=1.01-2.36), a previous report of severe DED symptoms (OR=1.79, CI=1.07-3.00), having a tear break-up test performed (OR=2.73, CI=1.72-4.36), and with having either blepharitis or MGD (OR=0.59, CI=0.35-0.98).
Conclusions
The present study suggests that a proportion of DED patients experience worsening of their DED over time, tending to present with more severe symptoms earlier in the disease. Forthcoming data on the natural history of DED from prospective studies should help clarify some of the limitations of this retrospective study.