Characteristics and Risk Factors Associated With Diagnosed and Undiagnosed Symptomatic Dry Eye Using a Smartphone Application

Abstract

The incidence of dry eye disease has increased; the potential for crowdsource data to help identify undiagnosed dry eye in symptomatic individuals remains unknown.OBJECTIVE To assess the characteristics and risk factors associated with diagnosed and undiagnosed symptomatic dry eye using the smartphone app DryEyeRhythm. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study using crowdsourced data was conducted including individuals in Japan who downloaded DryEyeRhythm and completed the entire questionnaire; duplicate users were excluded. DryEyeRhythm was released on November 2, 2016; the study was conducted from November 2, 2016, to January 12, 2018.EXPOSURES DryEyeRhythm data were collected on demographics, medical history, lifestyle, subjective symptoms, and disease-specific symptoms, using the Ocular Surface Disease Index (100-point scale; scores 0-12 indicate normal, healthy eyes; 13-22, mild dry eye; 23-32, moderate dry eye; 33-100, severe dry eye symptoms), and the Zung Self-Rating Depression Scale (total of 20 items, total score ranging from 20-80, with Ն40 highly suggestive of depression). MAIN OUTCOMES AND MEASURESMultivariate-adjusted logistic regression analysis was used to identify risk factors for symptomatic dry eye and to identify risk factors for undiagnosed symptomatic dry eye.RESULTS A total of 21 394 records were identified in our database; 4454 users, included 899 participants (27.3%) with diagnosed and 2395 participants (72.7%) with undiagnosed symptomatic dry eye, completed all questionnaires and their data were analyzed. A total of 2972 participants (66.7%) were women; mean (SD) age was 27.9 (12.6) years. The identified risk factors for symptomatic vs no symptomatic dry eye included younger age (odds ratio [OR], 0.99; 95% CI, 0.987-0.999, P = .02), female sex (OR, 1.99; 95% CI, 1.61-2.46; P < .001), pollinosis (termed hay fever on the questionnaire) (

A Review of Dry Eye Questionnaires: Measuring Patient-Reported Outcomes and Health-Related Quality of Life

“…There are often inconsistencies between the clinical findings and subjective symptoms of DED [12,[14][15][16][17]; moreover, DED adversely affects patients' HRQL [6][7][8][9][10][11][12]. Therefore, there is a need to accurately determine the subjective DED symptoms and their impact on a patient's daily life through reliable and valid questionnaires created in accordance with the PRO guidance.…”

“…Notably, at least one positive finding among the markers for tear film homeostasis loss should constitute DED diagnosis [13]. However, inconsistencies often occur among subjective symptoms, HRQL, and the examination-based clinical findings of patients with DED [12], since many of them lack subjective symptoms or experience a lower HRQL than that suggested by their clinical findings [14][15][16][17]. A questionnaire may lack sensitivity, particularly in cases with neurotrophic alterations due to or accompanied by DED, which could result in a decreased corneal sensation and hence less symptomology [18,19].…”

“…Future improvements in personalized medicine for dry eye treatment are expected [16,17,26,27]. In personalized medicine, rather than employing standardized treatment, the treatment methods are based on the severity and extent of an individual's condition and subjective symptoms [17]. Therefore, the accurate evaluation of subjective symptoms will play an increasingly significant role in medical care.…”

Comparing the Japanese Version of the Ocular Surface Disease Index and Dry Eye-Related Quality-of-Life Score for Dry Eye Symptom Assessment

“…DED consists of a variety of subjective symptoms. Therefore, it is important to objectively monitor the subjective symptoms for DED screening and treatment evaluation [4][5][6]. In this study, we compared two questionnaires for dry eye subjective symptoms, the J-OSDI and DEQS, which can be only used in Japan.…”

“…Dry eye disease (DED) is one of the most common eye disorders affecting 5-50% of the population, and it is becoming more prevalent due to the ageing population and the increase in digital work [1][2][3][4]. It has become clear from previous large-scale crowdsourced research on real-world data collected using the iPhone application "DryEyeRhythm" that many people with dry eye symptoms remain undiagnosed [4][5][6]. DED causes various symptoms affecting ocular and visual function that interfere with the quality of vision and reduce work productivity [7,8].…”