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Kimberley Yu, Vatinee Y Bunya, Maureen G Maguire, Penny A Asbell, Gui-Shuang Ying; Systemic conditions associated with the severity of dry eye signs and symptoms in the Dry Eye Assessment and Management (DREAM) Study. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1223.
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Certain systemic conditions are reported to be risk factors for dry eye disease (DED), but their associations with DED severity are not well studied. We evaluated whether systemic conditions reported to be DED risk factors are associated with the severity of DED signs and symptoms via secondary analysis of data from the DREAM Study, a large-scale multi-center randomized clinical trial of patients with moderate-to-severe DED.
535 patients with moderate-to-severe DED from 27 US centers reported their medical history at baseline. At baseline, 6 months, and 12 months, patients were assessed for DED symptoms using the Ocular Surface Disease Index (OSDI) and for six DED signs: tear break-up time, Schirmer’s test with anesthesia, corneal staining, conjunctival staining, tear osmolarity, and meibomian gland dysfunction. A composite signs severity score with range 0 to 1, with 1 being most severe, was calculated from the six DED signs. We analyzed the associations of systemic conditions reported as potential DED risk factors with the severity of DED signs and symptoms using generalized linear regression models adjusted by age, sex, race, and visit. To be included, conditions had at least 25 patients.
The mean±SD age was 58±13.2 years, and 81% were female. More severe DED signs were significantly associated with Sjögren’s syndrome (composite mean±SD: 0.52±0.17 with disease vs. 0.43±0.13 without disease, p<0.001), facial rosacea (0.47±0.13 vs. 0.43±0.13, p=0.002), rheumatoid arthritis (0.47±0.14 vs. 0.42±0.12, p=0.002), peripheral artery disease (0.50±0.14 vs. 0.43±0.13, p<0.001), and daily smoking history (0.45±0.13 vs. 0.43±0.13, p=0.047) (Table 1). Thyroid dysfunction, osteoarthritis, diabetes, irritable bowel syndrome, hypercholesterolemia, hypertension, and hypertriglyceridemia were not significantly associated with DED signs. No conditions were significantly associated with OSDI (Table 2).
In this large, well-characterized cohort of DED patients assessed under standardized procedures, the presence of certain systemic diseases and smoking were associated with more severe DED signs. The profile of significant DED signs varied by systemic condition, reflecting different DED etiologies. Understanding the systemic conditions and underlying etiologies that predispose some patients to more severe DED can improve management.
This is a 2021 ARVO Annual Meeting abstract.
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