Impact of Conjunctivochalasis on Visual Quality of Life: A Community Population Survey

Abstract

Conjunctivochalasis (Cch) is a very common ocular disorder, which can cause an unstable tear film and ocular discomfort. The study of vision-related quality of life (VR-QoL) in a community population with Cch can provide a better understanding of the impact of Cch on common people than objective clinical examinations alone. This cross-sectional comparative study enrolled 360 participants ≥40 years old living in Sanle Community, Shanghai. In the study, 198 subjects were diagnosed with Cch and 86 with dry eye syndrome (DES) without Cch. The remaining 76 subjects were normal controls. Socio-demographical data were collected, and Cch and related ocular symptoms and signs were evaluated. In addition, all participants were required to complete the Chinese version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and Ocular Surface Disease Index Questionnaire (OSDI). Main outcome measures include the comparison on the OSDI score and VFQ-25 score among the subgroups, and the correlation of these scores with the socio-demographical and clinical data. The results revealed that subjects with Cch had significantly decreased tear film stability even compared with those with DES (P = 0.001). The participants with either Cch or DES reported significantly higher OSDI scores and lower VFQ-25 composite scores than the normal controls (P<0.001 and 0.007 respectively). Further comparisons among the subgroups of Cch revealed that the following factors were associated with higher OSDI scores and lower VFQ-25 composite scores: nasal-side Cch, chalasis folds higher than tear meniscus height, punctal occlusion, or increased extent of chalasis on digital pressure. In conclusion, Cch was associated with an adverse impact on VR-QoL in a community population, and the impairment in VR-QoL had a significant correlation with disease severity and tear film abnormalities.

The effect of ageing on the ocular surface parameters

“…The eyelid laxity, more common in older individuals, has been reported to be associated with dry eye symptoms and abnormal tear parameters. It has impacts on tear function that lead to a greater exposure and increased irritation [49,50], which could explain our findings regarding the increased ocular redness with age.…”

The Impact of Conjunctivochalasis on Dry Eye Symptoms and Signs

“…Similar to dry eye, Cch has been found to be more frequent in older individuals 6,7 and adversely affects vision-related quality of life. 8 In fact, one study in a German population demonstrated that the presence of any Cch was associated with dry eye symptoms. 9 Two other studies in Chinese and German populations examined Cch location and found that nasal conjunctivochalasis (NCch) was associated with higher dry eye symptoms compare with nonnasal conjunctivochalasis (non-NCch) and no conjunctivochalasis (no-Cch).…”

“…9 Two other studies in Chinese and German populations examined Cch location and found that nasal conjunctivochalasis (NCch) was associated with higher dry eye symptoms compare with nonnasal conjunctivochalasis (non-NCch) and no conjunctivochalasis (no-Cch). 8,10 With respect to signs, several studies in Chinese, Japanese, and German populations have demonstrated an association between NCch and bulbar conjunctival hyperemia, 10 decreased tear film stability, 8 and higher rose Bengal staining scores. 5 Despite the abundance of data internationally, the epidemiology of Cch has not been as well studied in the United States.…”

Therapeutic Strategies to Treat Dry Eye in an Aging Population

“…Anatomic changes, such as conjunctivochalasis and eyelid laxity are associated with DE symptoms and abnormal tear parameters [40-41]. As with other involution changes, both of these entities are more common in older individuals [40, 42-43].…”