Association Between Depression and Severity of Dry Eye Symptoms, Signs, and Inflammatory Markers in the DREAM Study

Abstract

IMPORTANCE Depression is more prevalent in patients with dry eye disease (DED) than in the general population; however, the association between severity of DED and depression needs further evaluation.OBJECTIVE To investigate the association between depression and severity of DED symptoms and signs, including inflammatory markers. DESIGN, SETTING, AND PARTICIPANTS Secondary cross-sectional and longitudinal analysis performed in April to December 2020 of data from Dry Eye Assessment and Management (DREAM) study, a randomized clinical trial from October 2014 to July 2016 including patients with moderate to severe symptoms and signs of DED. Enrolled from 27 ophthalmology and optometry centers, both academic and private, in 17 US states, 535 patients were followed up for 1 year. EXPOSURE Participants screened positive for depression if they scored 42 or less on the Mental Component Summary (MCS) of the 36-Item Short Form Health Survey.MAIN OUTCOMES AND MEASURES Symptoms of DED were assessed by Ocular Surface Disease Index (OSDI) and Brief Ocular Discomfort Index (BODI) and signs assessed by tear film breakup time, Schirmer test, corneal and conjunctival staining, tear osmolarity, and meibomian gland dysfunction at baseline, 6 months, and 12 months. A composite severity sign score was calculated from all 6 signs. Inflammatory markers (cytokines in tears and HLA-DR expression by conjunctival surface cells) were measured for some trial participants. Features of DED were compared between participants with and without depression and adjusted for age, sex, race, visits, and baseline comorbidities.RESULTS Among the 535 participants, mean (SD) age was 58 (13.2) years, 434 participants (81%) were women, and 398 (74.4%) were White. Participants who screened positive for depression had worse DED symptoms by OSDI (effect size = 0.45, P < .001) and BODI (effect size = 0.46, P < .001) and composite DED sign score (effect size = 0.21, P = .006). Lower MCS score (ie, worse depression) was correlated with higher OSDI score (ie, worse DED symptoms) at baseline (Spearman ρ = −0.09, P = .03), 6 months (ρ = −0.20, P < .001), and 12 months (ρ = −0.21, P < .001). Inflammatory markers did not differ by depression status.CONCLUSIONS AND RELEVANCE Depression was associated with more severe dry eye symptoms and overall signs, suggesting that among patients with moderate to severe DED, those with depression may be likely to have more severe DED. These findings support consideration of depression as a comorbidity when managing patients with DED. Further study is needed to elucidate the relationship.

Prevalence and associations of dry eye disease and meibomian gland dysfunction in the ural eye and medical study

“…Kim and associates also reported in their population-based cross-sectional study a positive correlation between depression and dry eye symptoms 46 . In the Dry Eye Assessment and Management (DREAM) study, a recent multicenter randomized clinical trial of 535 patients with moderate to severe DED, individuals with depression had worse DED symptoms, and a higher degree of depression was associated with worse DED symptoms 48 . The DREAM study had primarily been designed to evaluate the effect of omega-3 supplements on the symptoms and signs of dry eye disease relative to placebo supplement 49 .…”

The ocular symptoms and signs during the COVID-19 pandemic

“…The symptoms and signs of dry eye disease may not always correlate, which is not well understood [ 42 ]. Regarding non-visual symptoms, the prevalence of discomfort increased probably due to mental stress and depression as a consequence of the pandemic [ 15 ]. Moreover, outpatients may be more anxious about visual symptoms than non-visual symptoms.…”

“…Indeed, telework has negative and positive effects on ocular symptoms and signs. The negative effects include digital eye strain [12,[39][40][41] and increased risk of DE due to increased screen time [13,14], excessive near work [11], sedentary behaviors [35], and mental stress [15]. Salinas-Toro et al [12] described the high frequency of digital eye strain and dry eye disease in teleworkers during the coronavirus pandemic.…”

“…The risk of dry eye (DE) may increase in quarantine due to increased screen time [ 14 ] and depressive mental status [ 15 ]. However, one study revealed a trend of decreasing BUT for five consecutive years before the pandemic [ 16 ].…”

Acacetin protects against depression-associated dry eye disease by regulating ubiquitination of NLRP3 through gp78 signal

“…Dry eye disease is defined as a “multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface ( Messmer, 2015 ). Previous researches demonstrate that it frequently occurs with depression ( Zhang et al, 2019 ; Zhou et al, 2022 ). However, the treatment for depression-associated dry eye disease has not been fully studied.…”