About the survey data in this poster

“Dry Eye Disease and Me” was conducted between 2019-2021. Read more here.

Below are links to summary data on the specific questions used in this poster. Please see main menu for all available data types.

Symptom data

Quality of life

We’re looking for research partners

Contact survey@dryeyefoundation.org 

Abstract

CHRONIC OCULAR SURFACE PAIN AS A DEFINING CHARACTERISTIC OF DRY EYE DISEASE

Rebecca Petris, Aidan Moore, Sandra Brown MD - Dry Eye Foundation, Poulsbo, WA, USA.

PURPOSE: Dry Eye Disease (DED) is characterized by ocular surface disease (OSD) and ocular surface pain (OSP). Discordance between the severity of OSD and OSP is common. OSP is a frequent motivation for DED patients to seek eye care and it is considered chronic if it persists or recurs for more than 3 months. Clinical research and industry innovation prioritize OSD, while DED patients prioritize relief of OSP. Using patient-reported outcomes, we investigated Chronic Ocular Surface Pain (COSP) and its impact on quality of life (QoL) in order to better understand DED patient satisfaction and to suggest additional research pathways.

METHODS: We deployed a 500-question survey to DED patients via email, social media and support groups. The survey asked quantitative, qualitative and open text questions about respondents’ DED symptoms, including type, severity, persistence, chronicity, and functional and emotional impacts. Additional survey topics included diagnoses and risk factors, efficacy of treatments and remedies, experiences with healthcare, and financial impact.

RESULTS: 480 DED patients completed the survey. The average respondent ranked 9 distinct OSP symptoms (SD = 4) in the top two points of a 4-point Likert scale. On a visual analog scale of 0-10, respondents rated their symptom severity on a typical day as 4.89; best days, 3.26; worst days, 6.81; and worst ever, 8.05. 82% of respondents thought about or were aware of their eyes at least half the time (all of the time 15%, most 35%, half 32%, some 16%, none 2%). 61% experienced reduced work productivity due to DED; 14% had to leave a job due to DED. 29% of respondents reported ever having been housebound by DED. The past and present mental health impact of DED was reported to be anxiety (63%), depression (47%) and suicidal ideation (15%). Only 23% of respondents felt hopeful or optimistic about the future of their DED symptoms.

DISCUSSION: DED patients’ unmet need for symptom relief is a significant constraint on treatment adherence and patient satisfaction. Our research shows that, based on the IASP definition of pain, most symptoms reported by chronic DED patients are COSP symptoms. However, COSP is not a major focus for DED research or development of therapies. There are no FDA-approved COSP drugs and we are aware of just 2 in the pipeline, compared with 7 approved for DED and ~20 in the pipeline. Our research suggests the need for a shift in thinking from “DED symptoms” to “chronic pain” as an important paradigm for DED treatment research. The lack of validated psychometric outcome measures for COSP will limit the development of effective therapies. Further analysis of our survey data is needed.

CONCLUSIONS: Our work shows that COSP and its QoL impacts are dominant features of the DED patient experience. Like other chronic pain syndromes, COSP is a distinct health condition requiring treatment. Our findings suggest that in order for DED patient outcomes to improve, COSP must become its own endeavor in DED research and industry innovation.

References

1. Craig, JP et al. 2017. TFOS DEWS II Definition and Classification Report. The Ocular Surface. Jul;15(3):276-283. doi: 10.1016/j.jtos.2017.05.008

2. Ong ES et al. 2018. Epidemiology of discordance between symptoms and signs of dry eye. British Journal of Ophthalmology. May;102(5):674-679. doi: 10.1136/bjophthalmol-2017-310633

3. Bradley JL et al. 2019. Clinical Ophthalmology. Dry eye disease ranking among common reasons for seeking eye care in a large US claims database. 13: 225–232 PMCID: PMC6362914.

4. Nicholas, M et al. 2019. Pain. The IASP classification of chronic pain for ICD-11: chronic primary pain. 160(1):p 28-37, January 2019. | DOI: 10.1097/j.pain.0000000000001390

5. Saldanha, I et al. 2018. JAMA Ophthalmology. Research questions and outcomes prioritized by patients with dry eye. 2018;136(10):1170-1179. doi:10.1001/jamaophthalmol.2018.3352

6. Uchino M et al. 2022. Journal of Clinical Medicine. Adherence to Eye Drops Usage in Dry Eye Patients and Reasons for Non-Compliance: A Web-Based Survey. Jan 12;11(2):367. doi: 10.3390/jcm11020367

7. Gomez J et al. 2019. The Ocular Surface. The impact of dry eye disease treatment on patient satisfaction and quality of life: A review. Jan;17(1):9-19. doi: 10.1016/j.jtos.2018.11.003.

8. Raja SN et al. 2020. Pain. The Revised IASP definition of pain: concepts, challenges, and compromises. Sep 1;161(9):1976–1982. doi: 10.1097/j.pain.0000000000001939

Financial disclosures

Rebecca Petris is owner of the Dry Eye Company. Aidan Moore and Sandra Brown MD have no financial disclosures.