Association of proton pump inhibitors use with severity of dry eye symptoms and signs in the DRy Eye Assessment and Management (DREAM^©) Study

Abstract

Purpose : A recent large population-based hypothesis-free study found that proton pump inhibitors (PPIs) use is highly associated with presence of dry eye disease (DED) symptoms¹. In this study, we examined the association between PPIs use and severity of DED symptoms and signs among participants in the DREAM^© study, a multi-center randomized clinical trial to evaluate the effect of omega-3 fatty acid supplements for the treatment of dry eye.

Methods : At baseline, self-reported PPIs use and the specific drug name were collected using medication log. At baseline, 6 and 12 months, DED symptoms were evaluated using the Ocular Surface Disease Index (OSDI), DED signs in each eye were evaluated for tear break up time (TBUT), Schirmer’s test, corneal fluorescein staining, conjunctival lissamine green staining, and Meibomian gland dysfunction (MGD). Generalized linear models were used to compare the scores of DED symptoms and signs between PPIs users and non-users, with adjustment for age, gender, race, visit, history of acid reflux, comorbidities that were previously found to be associated with severity of DED symptoms and signs in the DREAM study. The correlation among repeated measures of DED symptoms and signs at baseline, 6 and 12 months and the inter-eye correlation of DED signs were accounted for by using generalized estimating equations.

Results : Among 535 participants with moderate-to-severe DED, 114 (21.3%) were PPIs users at baseline, with 71 (13.3%) using Omeprazole, and 22 (4.1%) using Pantoprazole. Compared to PPI non-users, PPIs users were significantly older (mean [SD] age 62.7 [10.7] vs. 56.7 [13.5], p<0.001), more likely to self-report ongoing acid reflux (82.5% vs. 19.5%, p<0.001). When data from baseline, 6 and 12 months were combined, PPIs use at baseline was not associated with severity of dry eye symptoms or signs (Table 1, all adjusted p≥0.24). Specifically, uses of either Omeprazole or Pantoprazole were not associated with severity of DED symptoms or signs compared to non-users (Table 2, all adjusted p≥0.08).

Conclusions : Among DREAM participants with moderate-to-severe DED, PPIs use was not associated with severity of dry eye symptoms and signs.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.