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Louis Tong, Li-Yue Hong, Ryan Lee, Yang Zhao, Sharon Sung, Peggy Chiang; The relationship of depression and anxiety with dry eye subtypes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4357.
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Dry eye syndrome is a common, major health condition with association with systemic conditions such as depression and anxiety. We aim to use two previously validated questionnaires to evaluate depression and anxiety in ambulatory eye care setting, and determine if specific dry eye subtypes are associated with these conditions.
This is a prospective cross sectional study performed on English literate patients at the Singapore National Eye Center. Participants were tasked to complete 2 interviewer-assisted questionnaires: HADS, which screens for anxiety and depression, and CESD, which screens for depression. All participants underwent a dry eye symptom questionnaire, tear break up time assessment, corneal fluorescein dye staining, Schirmer’s test, as well as a socioeconomic questionnaire assessment. Patients were classified into evaporative, aqueous deficient or mixed types or symptomatic categories based on their response to questions and the above test results.
Ninety-six people, mean age 54.5 year (SD: 10.8), of which 35.9% men, were recruited. The mean score for CESD was 12.1 (9.8) with 28 subjects (31.5%) having a score of above 16 (previously published threshold). In the HADS the mean score for depression-associated questions was 3.6 (3.6) with 13 subjects (14.1%) having a score >=8 whereas mean score for the anxiety-associated questions was 5.3 (3.6) with 24 subjects (26.1%) having a score >=8. Abnormal CESD was significantly associated with symptomatic aqueous deficient and evaporative dry eyes, mixed dry eyes, and symptomatic mixed dry eyes (odds ratios range from 3.4 - 4.0). The anxiety scores from HADS were significantly associated with symptomatic evaporative and symptomatic mixed dry eyes (odds ratios range (3.04 - 3.2), but the HADS depression scores were not associated with any dry eye subtypes.
The CESD and HADS were able to detect suspects with depression and anxiety respectively. Specific types of dry eye patients, particularly symptomatic ones, showed different tendencies for depression and anxiety. The results of these studies have implications for the management of chronic dry eye patients as well as healthcare planning.
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