Quality of life and dry eye disease severity in people with diabetes

Purpose : To assess the interrelationship between the severity of dry eye disease (DED) and the quality of life (QoL) in people with diabetes. Methods : A pilot study of subjects with diabetes (n=17) and without diabetes (n=16, controls) investigated the severity of DED using the Ocular Surface Disease Index (OSDI) questionnaire, and QoL using the Dry Eye-related Quality of Life Score (DEQS) questionnaire. Subjects also underwent objective clinical assessment for DED, via the Schirmer I test (tear volume) and NITBUT (tear quality). Demographic and related medical information (i.e. presence of diabetic retinopathy [DR], HbA1c levels and duration of diabetes) was also assessed. Results : DED symptoms were noted in 58.8% of subjects with diabetes (17.65% mild, 11.76% moderate and 29.41% severe), and in 25% of controls (mild DED only). Moreover, DED severity was significantly higher in those with diabetes (OSDI=22.9±22.0) versus controls (OSDI=7.4±5.6; p=0.034). Diabetic patients also showed a significantly lower QoL (DEQS=31.6 ±25.2) than controls (DEQS=9.1±8.2; p=0.002). No significant difference was noted for the tear volume (Schirmer) between those with diabetes (14.9±11.9) and controls (20±10.7; p=0.136). However, tear quality (NITBUT) was significantly reduced in diabetic subjects (8.5±2.9 secs) versus controls (10.6±3.4 secs; p=0.026). A strong positive association was found between the severity of DED and its effect on QoL of diabetic participants (p<0.001; Spearman’s rho=0.912). DED was not associated with duration of diabetes, HbA1C level or DR. In those with diabetes, the study detected a moderate negative correlation between OSDI and NITBUT (p=0.011; Spearman’s rho=-0.617), but there was no correlation between tear volume (Schirmer) and DED severity (OSDI; p=0.806, Spearman’s rho=0.064). Conclusions : This study demonstrated a strong positive association between severity of DED and reduced QoL in diabetic participants. This suggests that diabetes has a greater impact on DED-related QoL of this patient demographic. Therefore, clinical assessment and screening for DED should be included in routine follow-up of patients with diabetes