Depression May Be Connected To More Severe Dry Eye Disease

Gui-shuang Ying, MD, PhD

Recent findings observed associations between depression and more severe dry eye disease symptoms and overall signs, suggesting patients with depression may be more likely to have a severe case of the disease.

Those who screened positive for depression had worse symptoms, more ocular discomfort, worse corneal staining scores, and worse composite severity scores of dry eye disease signs in comparison to participants who screened negative for depression.

“Our participants who screened positive for depression also had worse mean composite DED sign scores (although with smaller effect size than DED symptoms) and corneal staining scores, suggesting DED severity of signs, rather than patient perception alone, may have a role in an association between DED and depression,” wrote study author Gui-shuang Ying, PhD, Perelman School of Medicine, University of Pennsylvania.

The study was a secondary analysis of data from the 12-month, multicenter Dry Eye Assessment and Management (DREAM) evaluating the efficacy of ω-3 fatty acid supplements in comparison to placebo utilizing the score of Ocular Surface Disease Index (OSDI) as the primary outcome.

From October 2014 - July 2016, a total of 535 participants were enrolled from 27 clinical centers in 17 states and randomized 2:1 in the study. Eligibility criteria included age ≥18 years, dry eye disease symptoms for ≥6 months, use of artificial tears at least twice a day for 2 weeks, and OSDI score of 25 - 80 at a screening visit and 21 - 80 at baseline.

Patients screened positive for depression if they score ≥42 on the Mental Component Summary (MCS) of the 36-item Short Form Health Survey. Additionally, Participants had evaluations of symptoms, signs, and inflammatory markers and depression at baseline and 6-month and 12-month visits.

The symptoms of dry eye disease were assessed by the OSDI and Brief Ocular Discomfort Index (BODI), with signs assessed by:

• Corneal fluorescein staining
• Tear film breakup time (TBUT)
• Schrimer test
• Corneal and conjunctival staining
• Tear Osmolarity
• Melbomian gland dysfunction at baseline, 6 months, and 12 months

Among a total of 535 participants in DREAM, the mean age was 58 years, with 434 (81%) were women and 398 (74.4%) were White. Data show 84 (15.7%) had depression ≤42 on MCS) at baseline, with 82 (17.3%) at 6 months and 64 (13.2%) at 12 months (P = .32 and P = .09 compared with baseline).

The lower MCS scores were correlated with higher OSDI scores at baseline (ρ = -.0.09, P = .03), 6 months (ρ = -0.20, P <.001) and 12 months (ρ = -0.21, P <.001). However, investigators observed the change in MCS score from baseline was not associated with change in OSDI score at 6 months (ρ = -0.03, P = .52) or 12 months (ρ = -0.04, P = .36).

Individuals who screened positive for depression had a higher mean OSDI score (42.2 versus 33.9) and more severe ocular discomfort on the BODI (45.5 versus 35.7), compared to those who screened negative for depression (P <.001)

Moreover, participants who screened positive for depression had worse dry eye disease symptoms by OSDI (effect size = 0.45, P <.001) and BODI (effect size = 0.46, P <.001) and composite dry eye disease sign score (effect size

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).

The study, “Association Between Depression and Severity of Dry Eye Symptoms, Signs, and Inflammatory Markers in the DREAM Study,” was published in JAMA Ophthalmology.