Photophobia Reduces Quality of Life and May Hide Systemic Disease

Patients with photophobia often experience migraines, dry eye, and mental health conditions, which all contribute to lower visual quality of life according to a study presented at the 2020 North American Neuro-Ophthalmology Society Annual Meeting. Also, the study found major discrepancies between what patients say about how their photophobia impacted their lives and the results of the screening instruments, leading the researchers to conclude that some conditions are being underdiagnosed. 

Photophobia, which is sensitivity or aversion to light, is a common complaint in ophthalmology and neurology clinics. While this condition comes up frequently, the study sought to uncover how exactly photophobia impacts patients’ visual quality of life. 

Participants were identified by evaluating Moran Eye Center Epic records from June 2015 through June 2020. The study included patients 18 years and older who were diagnosed with photophobia and spoke English as their primary language. It excluded patients whose best corrected visual acuity in either eye was worse than 20/40, or if anyone with a history of significant corneal diseases or degeneration, uveitis, retinal disease, severe glaucoma, or a homonymous visual field defect. 

A survey was deployed via email to 409 patients who met the inclusion criteria and included a general questionnaire and previously validated survey tools, including a migraine screen, depression screen, anxiety screen, and a photophobia symptom impact scale. The survey also included the National Eye Institute Visual Function Questionnaire 25, which the researchers describe as a “previously validated survey that measures the influences of visual disability and visual symptoms on emotional well-being and daily function.”

A total of 46 people completed the survey, (32 women; average age 49.7). Nearly all (42) of participants identified as White. 

The results show that many of the participants are photophobic most of the time and that the domains of general health, ocular pain, role difficulties, mental health and near activities were most impacted. Approximately 20% of participants had positive depression or anxiety screen, or both. 

Also, the results suggest that many patients are unaware that they suffer from dry eyes and migraines: 91% had a positive dry eye screen and 72% had a positive migraine screen, though only 6 reported dry eye and 16 reported migraines. 

Since it appears that dry eye and migraine may be underdiagnosed in this population, practitioners have an opportunity to screen and treat more patients with photophobia. Also, a takeaway from this study practitioners can use is the increased impact on mental health and the prevalence of mental health conditions in patients with photophobia and provide referrals as needed. 

Reference

Redfern A, Peralta L, Arbon J, et al. The visual quality of life in patients with photophobia. Presented at: North American Neuro-Ophthalmology Society Annual Meeting; February 20-23, 2021; Poster 134.