Patient barriers and facilitators for making environmental and behavioral modifications for dry eye in the United States

Abstract

Purpose : Dry eye disease (DED) has a significant economic impact on patients and society. In large surveys in 2017 and 2018, clinicians and patients ranked the effectiveness of environmental and behavioral modifications among the most important dry eye-related research priorities. Given the importance of these modifications, we aimed to investigate the barriers and facilitators of their use by patients and how their use may be impacted by social and economic factors.

Methods : Using Qualtrics®, we conducted an anonymous survey of adults with DED in the United States in August-September 2022. Patients were identified through the Dry Eye Foundation, Sjogren’s Foundation, and a dry eye clinic the University of Colorado. We used an established index for classifying respondent socioeconomic status (SES) based on education, household income, and employment. When respondents did not report at least one of these variables, we classified their SES as unclear. We also assessed DED characteristics.

Results : We included 754 survey respondents (SES: 382 low, 275 high, and 97 unclear). Most respondents were aged 18 to 49 years (67%), female (68%), and White (76%). Most reported dealing with DED for ≤5 years (67%), and most reported that their eyes felt uncomfortable some (44%) or most (41%) of the time in the preceding 4 weeks. The most frequent modifications being used were: taking breaks to rest eyes (68%), increasing water intake (68%), and using hot or cold compresses (52%). For each of these three modifications, the biggest facilitators were: belief that it works (27% to 37%), being recommended to use/do it (24% to 26%), and ease of use/performance (21% to 32%) (Table). Across modifications, the biggest barriers to use were: difficulty of use (55%), lack of family/employer/social/community support (33%), and lack of awareness (32%). The data do not suggest discernible patterns of differences in barriers or facilitators by SES.

Conclusions : Greater emphasis should be placed on making patients aware and explaining to them how environmental and behavioral modifications might mitigate DED. Lower SES may not be associated with greater barriers to use of these modifications. Employers and members of patients’ support systems (e.g., family members) should be guided regarding how best to support patients in managing DED.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.