Dry Eye Disease Affects Life Quality in Sjögren’s Patients: Study

Patients report far-reaching impact of symptoms on day-to-day life

Teresa Carvalho, MS avatar

by Teresa Carvalho, MS |

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Dry eye disease (DED) was found to significantly affect health- and vision-related quality of life in people with Sjögren’s syndrome in a new study.

Patients with Sjögren’s “have a lower perceived [life quality] especially in relation to physical and mental wellbeing, correlating to severity of DED symptoms and treatment burden,” the researchers wrote.

The team emphasized that clinicians should be mindful of the perceptions of individuals with these symptoms, and consider the “reaching and enduring implications of DED on these patients’ day-to-day life.” The study also stressed the importance of assessing patient-reported outcomes and visual acuity.

The study, “Relationship between clinical parameters and quality of life in primary Sjögren’s Syndrome: a prospective study,” was published in the journal Eye.

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Sjögren’s syndrome is a chronic autoimmune disease in which the immune system mistakenly attacks the body’s own cells and tissues. In Sjögren’s, this attack is mainly directed against cells found in the glands that produce saliva and tears, causing the mouth and eyes to be constantly dry.

DED in particular can lead to “eye fatigue and blurring of vision throughout the day, as well as discomfort, pain and stinging,” the researchers wrote.

These symptoms carry a significant burden for the patient, as it can affect their quality of life, daily functioning, productivity, and emotional well-being.

As such, a team of researchers in Ireland and the U.K. led a study to quantify the effect of DED on perceived health and vision-related quality of life (HR-QoL and VR-QoL) in a group of patients with Sjögren’s syndrome.

HR-QoL and VR-QoL were both assessed through self-administered questionnaires. Eye tests also were performed and included the LogMAR measurement of visual acuity — a chart of rows of letters widely used in ophthalmology to estimate visual acuity.

Other eye tests included ocular surface staining, in which non-toxic stains are applied to the surface of the eyes to evaluate the tear film and show areas of eye surface damage.

“In doing so, we sought to highlight the reaching impact of DED beyond that of the ocular [eye] surface on the QoL of patients with [Sjögren’s],” the researchers wrote.

The study included a total of 34 patients — 28 women and six men — with an average age of 61.3. Each had moderate to severe dry eye disease.

Results showed that although most of the patients had good visual acuity, their scores on the VR-QOL questionnaire were low, suggesting a change in functional vision related to DED.

Clinical signs of [dry eye disease] can poorly correlate with patient symptoms, and thus underestimates their impact on the [quality of life] of patients with DED.

These findings “support the wider use of self-administered questionnaires … to measure patient reported outcomes and well-being in clinical practice to assist in therapeutic decision-making,” the researchers wrote.

Ocular surface staining findings were not related to DED symptoms nor QoL, the team found.

Given this result, the researchers noted that it’s important that clinicians are aware “that clinical signs of DED can poorly correlate with patient symptoms, and thus underestimates their impact on the QOL of patients with DED,” the team wrote.

Researchers also stressed that clinicians should take patient reported symptoms and outcomes into account “when judging disease severity and the effectiveness of treatment to ensure the appropriate management of DED.”

A moderate to strong negative association was found both for the use of eye lubricants and symptom severity with VR-QoL and HR-QoL, particularly in regard to physical and mental health.

Data also demonstrated that Sjögren’s patients had a lower HR-QoL when compared with age- and sex-matched individuals without the disease.

Treatment of Sjögren’s-related DED symptoms “should be optimised with the ultimate aim of reducing discomfort and improving patients’ [quality of life],” the team concluded.