Work productivity, daily activity plummet with dry eye disease severity

Severe dry eye disease (DED) is more than a nuisance, as new findings demonstrate an association between elevated ocular surface disease index (OSDI) scores and diminished workplace productivity and daily activity.

Published in the journal Ophthalmology, the new study found that higher OSDI symptom scores were associated with greater absenteeism, presenteeism and activity impairment, while overall work and activity impairment increased 4.3% and 4.8%, respectively, with every 10-unit increase in OSDI scores. The data clearly depict the difficult toll of patients’ DED and underscores routine eye care’s necessity for early prevention, detection and management efforts.

A common, often chronic problem that affects as many as 6.8% of the U.S. adult population, dry eye is a multifactorial disease of the ocular surface where tear production and drainage aren’t in proper balance. The Tear Film & Ocular Surface Society (TFOS) Dry Eye Workshop II further notes that DED is often accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.

Coupled with a high prevalence and widespread age range of patients, DED exacts a heavy burden on many Americans. But how damaging can DED be from an economic perspective? That’s what researchers with the multicenter Dry Eye Assessment and Management (DREAM) study sought to determine.

Per the study, researchers analyzed 535 adults with symptomatic moderate-to-severe DED (baseline 21 OSDI score) who filled out OSDI and Work Productivity and Activity Impairment (WPAI) questionnaires at baseline, six and 12 months. Initially, 52% of the cohort were employed with this subset reporting a reduction of nearly 20% in their overall productivity due to health reasons. Across the whole study group, the average level of impairment on performing regular activities was nearly 25% due to health reasons.

Significantly, researchers noted that OSDI score maintained a significant association under a longitudinal analysis of the data, controlling for demographics and comorbidities. In patients who experienced worsening OSDI over the course of the study, every 10-unit increase in OSDI was associated with a 2% decrease in productivity and a 3% decrease in activity.

“Effective treatments that relieve DED symptoms, therefore, not only would improve patients’ quality of life but might also induce increases in their productivity,” the study notes. “For example, a treatment that on average decreases the OSDI of our study population from 44 to normal range (0-12) might have increased its productivity approximately 6%, assuming that productivity gains are accrued only when outside the normal OSDI range.”

Continually rubbing, adding drops ‘adds up to significant impact’

Kelly Nichols, O.D., Ph.D., University of Alabama at Birmingham School of Optometry dean and professor, and a member of the TFOS DEWS II Report, says these findings are consistent with previous work that also concluded dry eyes can cause missed work and loss of productivity in the workplace. Continual sensation, dryness or irritation is not only distracting but also time-consuming in terms of stopping to rub one’s eyes, looking away from work or adding drops, Dr. Nichols notes. Although seemingly small and benign, these actions routinely performed over the course of the day do add up to a significant impact on quality of life.

Dr. Nichols says it’s clear from this evidence that DED patients exhibit symptoms that may often get brushed aside with excuses—"I am too busy,” “my symptoms are manageable” or “it isn’t time for my annual eye exam.” But, if patients were aware of their lost productivity, they might seek professional eye health care much more readily.

“To put that impact in terms of ‘lost work productivity’ really rams home how debilitating unmanaged DED truly can be,” Dr. Nichols says. “It is important for doctors to ask about dry eye symptoms throughout the year—that way symptoms can be ‘caught’ and managed early.”

The latter stems directly from Dr. Nichols’ “dry eye mantra”: Ask, look, do something. At the outset, when patients present for their annual exam, doctors of optometry should inquire about dryness or irritation at any point in the year or how their eyes feel when they’re working, especially if spending a large amount of time in front of a screen. Dr. Nichols emphasizes that there may be a pattern to patient’s DED symptoms, and understanding those triggers is the name of the game.

“When a patient becomes aware that he/she might have a pattern, it is easier to anticipate treatment changes,” she notes. “There are several dry-eye therapies in development and testing, with new products being approved even as recently as this week. This gives hope to practitioners that better care for dry eye patients is possible.”

Want to learn more about dry eye and the TFOS DEWS II Report? Read more in the May 2017 edition of AOA Focus.