Purchase this article with an account.
Maya Bitar, Danny Olson, Mengbing Li, Gary Koch, Richard Davis; Sicca, Anxiety and Depression (SAD) Study. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3749.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Dry eye (DE) syndrome has been associated with depression and anxiety (DA). No studies have evaluated the effect of dry eye disease treatment on DA. The purpose of our study is to investigate the relationship between DE treatment and depression or anxiety.
Patients diagnosed with DE were enrolled and reevaluated at their next follow-up. The University of North Carolina Dry Eye Management Scale (DEMS), a previously validated questionnaire, was used to determine severity of DE symptoms. Generalized Anxiety Disorder Screener (GAD-7) and Personal Health Questionnaire Depression Scale (PHQ-8) were used to evaluate for anxiety and depression. Clinical signs of DE were assessed by Oxford staining, Schirmer test, tear break up time, and meibomian gland dysfunction grading. Data was analyzed using Wilcoxon signed rank test, Spearman correlations, regression and subgroup analysis.
Forty five patients were enrolled. Thirty five percent were receiving treatment for anxiety or depression at the time of recruitment. At initial presentation, DEMS correlated with GAD-7 (Spearman correlation (ρ)=0.4, p=0.004) and PHQ-8 (ρ=0.6, p<0.001). Interestingly, none of the objective clinical measures of dry eyes correlate with the measures of depression and anxiety. Thirty eight patients followed-up at a mean period of 12 weeks. UNC DEMS and GAD7 significantly improved from 5.8±1.8 to 4.6±2.2 (p = 0.01) and 5.6±5.5 to 3.3±4.6 (p = 0.05), respectively. PHQ8 tended to improve from 6.1±5.5 to 4.1±4.7, (p = 0.08). Change in DEMS correlated with change in PHQ-8 (ρ=0.3, p=0.05) but not with changes in GAD-7 (ρ=0.2, p=0.3); except for the subgroup of patients who were new to the clinic (ρ=0.8, p=0.004; ρ=0.7, p=0.02). The presence of a prior diagnosis of depression and the use of anti-depressive medications did not affect the association.
This study is unique based on its interventional prospective design and demonstrates a significant correlation between severity of DE and symptoms of depression. DE treatment has a positive impact on symptoms of DA in new patients presenting for dry eye evaluation. Larger studies are needed to better understand the effect of dry eye treatment on patients with coexistent depression or anxiety.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Regression analysis showing that change in PHQ8 (dPHQ8= PHQ8 at follow-up – PHQ8 at baseline) varies linearly in function of change in DEMS (dDEMS= DEMS at follow-up – DEMS at baseline). Regression coefficient = 0.7, p=0.01.
This PDF is available to Subscribers Only