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Abstract
Purpose (1) To determine the independent association of dry eye symptoms with health-related quality of life (HRQoL) in the Singapore population and (2) to further investigate which factors mediate this association.
Methods In this cross-sectional study, 7707 participants were included. The presence of dry eye symptoms was defined as experiencing at least one out of the six symptoms either ‘often’ or ‘all the time’. The EuroQoL-5 dimensions (EQ-5D) utility instrument (raw scores converted to UK time trade-off (TTO) values) was used to assess generic HRQoL and the overall score from the Visual Functioning Questionnaire for visual functioning. The association between dry eye symptoms and EQ-5D was investigated using multivariable linear regression, adjusting for demographic and socioeconomic information, comorbidities, systemic and ocular examinations results. Mediation analysis was used to determine whether certain factors mediated this association.
Results After adjusting for relevant factors, those with dry eye symptoms had significantly lower HRQoL (difference in EQ-5D TTO: −0.062 (95% CI −0.073 to –0.050)), with the inability to open eyes affected the most (−0.101 (95% CI −0.161 to –0.042)), followed by a sandy sensation (−0.089 (95% CI −0.121 to –0.058)), a burning sensation (−0.070 (95% CI −0.105 to –0.036)), red eyes (−0.059 (95% CI −0.082 to –0.036)), a dry sensation (−0.058 (95% CI −0.072 to –0.044)) and crusting of eyelids (−0.040 (95% CI −0.071 to –0.008)). Visual functioning and the presence of recent falls accounted for 8.63% (4.98%–14.5%) and 2.93% (0.04%–5.68%) of the indirect relationship between dry eye and HRQoL, respectively.
Conclusion Dry eye symptoms were independently associated with poor HRQoL. Moreover, this was partly mediated by reduced visual functioning and experiencing recent falls. Our results suggest that efforts to reduce severity of dry eye symptoms are essential to optimise patients’ overall functioning and well-being.
- cornea
- epidemiology
- ocular surface
- tears
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to this paper are tabulated in tables (either in the main paper or in supplemental tables).
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to this paper are tabulated in tables (either in the main paper or in supplemental tables).
Footnotes
Contributors All authors meet the ICMJE criteria for authorship. EWLL contributed in the planning, conception, designing of the project, statistical analysis, interpretation of data, writing of the paper and critical revision for intellectual content. CCYC contributed in the statistical analysis, interpretation of data, writing of the paper and critical revision for intellectual content. SN contributed in the planning, conception, designing of the project, statistical analysis, interpretation of data, writing of the paper and critical revision for intellectual content. EF contributed in the planning, conception, designing of the project, statistical analysis, interpretation of data, writing of the paper and critical revision for intellectual content. ELL contributed in the planning, conception, designing of the project, data acquisition and critical revision of the paper for intellectual content. CS contributed in the planning, conception, designing of the project, data acquisition and critical revision of the paper for intellectual content. C-YC contributed in the planning, conception, designing of the project, data acquisition and critical revision of the paper for intellectual content. LT contributed in the planning, conception, designing of the project, statistical analysis, interpretation of data, writing of the paper and critical revision for intellectual content. LT is the guarantor.
Funding The Singapore Epidemiology of Eye Diseases (SEED) study was supported by the Biomedical Research Council (BMRC) Grant 08/1/35/19/550 and the National Medical Research Council (NMRC) Grant STaR/0003/2008, Singapore. LT is funded by the National Medical Research Council (NMRC\CSA\017\2017).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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