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Functional impairment of reading in patients with dry eye
  1. Priya M Mathews1,
  2. Pradeep Y Ramulu1,
  3. Bonnielin S Swenor1,
  4. Canan A Utine1,2,
  5. Gary S Rubin3,4,
  6. Esen K Akpek1
  1. 1The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
  3. 3Institute of Ophthalmology, University College of London, London, UK
  4. 4Biomedical Research Centre for Ophthalmology, London, UK
  1. Correspondence to Dr Esen Karamursel Akpek, Director, Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, 600 North Wolfe Street, Maumenee Building #317, Baltimore, MD 21287-9238, USA; esakpek{at}


Background/aims To evaluate the impact of dry eye on reading performance.

Methods Out-loud and silent reading in patients with clinically significant dry eye (n=41) and controls (n=50) was evaluated using standardised texts. Dry eye measures included tear film break-up time, Schirmer's test and corneal epithelial staining. Symptoms were assessed by the Ocular Surface Disease Index (OSDI).

Results The dry eye group had a greater proportion of women as compared with the control group but did not differ in age, race, education level or visual acuity (p≥0.05 for all). Out-loud reading speed averaged 148 words per minute (wpm) in dry eye subjects and 163 wpm in controls (p=0.006). Prolonged silent reading speed averaged 199 wpm in dry eye subjects versus 226 wpm in controls (p=0.03). In multivariable regression models, out-loud and sustained silent reading speeds were 10 wpm (95% CI −20 to −1 wpm, p=0.039) and 14% (95% CI −25% to −2%, p=0.032) slower, respectively, in dry eye subjects as compared with controls. Greater corneal staining was associated with slower out-loud (−2 wpm/1 unit increase in staining score, 95% CI =−3 to −0.3 wpm) and silent (−2%, 95% CI −4 to −0.6 wpm) reading speeds (p<0.02 for both). Significant interactions were found between OSDI score and word-specific features (longer and less commonly used words) on out-loud reading speed (p<0.05 for both).

Conclusions Dry eye is associated with slower out-loud and silent reading speeds, providing direct evidence regarding the functional impact of dry eye. Reading speed represents a measurable clinical finding that correlates directly with dry eye severity.

  • Ocular surface
  • Vision

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