The Mental Health Costs of DED

A new study published in The Ocular Surface has provided fresh insights into the quality-of-life burden of dry eye disease (DED). Using real-world data from the international Save Sight Dry Eye Registry (SSDER), the authors note a pressing need for individualized treatment strategies for DED patients.

The study was undertaken by a team of ophthalmologists, optometrists, and researchers from Australia, New Zealand, the United Kingdom, Spain, France, Germany, and Nepal. A key finding revealed that individuals with mixed subtype DED (a combination of evaporative and aqueous-deficient DED), corneal neuropathic pain, a history of DED treatment, or past DED-related procedures had significantly worse symptoms, greater activity limitations, and reduced overall quality of life than those with only evaporative or aqueous-deficient DED alone. The finding suggests that mixed DED may represent a more advanced disease stage, correlating with greater impairment.

"We used Rasch analysis, a modern psychometric method, to refine commonly used dry eye assessment tools and generate reliable Quality of Life [QoL] data," explains Himal Kandel, Kornhauser Research Fellow at The University of Sydney and lead author of the study. “Our results highlight that DED is more than just a clinical condition – it significantly affects mental health, daily activities, and overall well-being.”

Gender disparities also figure, with women more frequently diagnosed with DED than men, even though the QoL impacts, once diagnosed, were similar across both genders.

The study also found a weak or non-existent correlation between clinical signs of DED and patient-reported symptoms, underscoring the need for independent assessment of both in clinical practice.

In terms of mental health impacts of the disease, the findings suggested that DED patients may benefit from psychological support. Anxiety-related concerns were more prevalent for DED patients than depression-related issues. DED symptoms were found to play a more significant role in mental health outcomes than clinical signs, visual acuity, or age.

Patients who were diagnosed with corneal neuropathic pain were observed to experience worse symptoms, greater activity limitations, and poorer mental health when compared to patients without neuropathic pain.

The study authors note that the Ocular Surface Disease Index (OSDI), the most commonly used questionnaire for DED, may benefit from validation with modern psychometric methods to ensure it provides an accurate assessment of dry eye disease-related quality-of-life impacts.

“These findings reinforce the need for a holistic approach to DED management,” adds Fiona Stapleton, Scientia Professor at the School of Optometry and Vision Science, UNSW Sydney. “A comprehensive assessment that includes both signs and symptoms is critical to ensure optimal patient care.”

Stephanie L Watson, study co-author and Chief Investigator of the Save Sight Dry Eye Registry project, added, “As DED continues to be a significant public health concern, studies like this pave the way for more effective, evidence-based management strategies that prioritise patient well-being and quality of life improvement.”