Dry Eye Disease Substantially Burdens Vision-Related Quality of Life

Optometrist Examining Patient
The effect on patients’ daily living can be as detrimental as vision-threatening conditions, a study suggests.

Dry eye disease (DED) reduces vision-related quality of life by a level on par with that of glaucoma, macular degeneration, and retinal detachment, according to an investigation published in The Ocular Surface. “Dry eye is a serious disorder that must be adequately diagnosed and treated in both young and old people,” report the study’s authors. Researchers also emphasize that DED imposes an extensive population burden due to its high prevalence and substantial impact.

Researchers reviewed 89,022 individuals (age range 18 to 96 years, 59% women) from the Dutch population-based “Lifelines” cohort. Participants were evaluated using 2 questionnaires to establish the effect dry eye symptoms have on overall vision-related quality of life. 

Participants were considered to have DED based on their response to the Women’s Health study (WHS) — a 3-item questionnaire for assessing dry eye in population-based studies, which has been validated against a standardized clinical exam defining dry eye as a Schirmer 1 value of 10 mm or lower or TBUT of 10 seconds or fewer in at least 1 eye. The effect their dry eye had on quality of life was measured with the Visual Function 25 Questionnaire (VFQ25) which, researchers say, “measures the dimensions of self-reported vision-targeted health status that are most important for people with chronic eye diseases.” 

The investigators monitored 10 domains of vision-related quality of life; color vision, distance activities, driving, general health, general vision, near activities, peripheral vision,  vision-related social functioning, vision-specific mental health, and worry. The study found 9.1% of participants had DED. These patients, as compared with those without DED, had a higher risk  of compromised average of the 10 domains (OR 3.12 (95%, CI 2.98-3.27), even when corrected for age, sex, BMI, income, smoking, and 55 other comorbidities). They also had substantial reductions in each individual domain, compared with patients without DED. Patients who had highly symptomatic DED had even more substantial reductions compared with patients without DED and compared with those who had a DED diagnosis based on the WHS, but were not highly symptomatic.

For instance, 7.3% of patients without DED reported trouble with vision-related social functioning. Among patients with WHS-diagnosed DED, that number was 13.1%, and it was 22.6% in those with highly symptomatic DED. Moderate-or-worse ocular pain was noted in 5.8% of patients without DED, 32.3% of those with WHS-diagnosed DED, and 78.7% of highly symptomatic patients. Vision-related problems driving affected 29.6% of the WHS-diagnosed cohort, and 43.1% of highly symptomatic patients. 

Although DED is not associated with vision loss the way that glaucoma, macular degeneration or retinal detachment can be, the results show that DED is strongly associated with self-reported reductions in near vision, vision, peripheral vision, color vision, vision-related social functioning, and driving, as well as increased ocular pain and general worry about eyesight, the researchers report. “In fact, dry eye had the largest population-wide impact on VR-QoL of all common eye diseases investigated in the present study due to the combined effects of its substantially decreased VR-QoL and its high prevalence in the population,” the study says. This suggests that patients’ experience with DED makes it a significant detriment. 

In this research, the participants had a much higher risk of compromised vision-related quality of life if their experience with dry eye was highly symptomatic, and that risk of reduced quality of life increases gradually with the frequency of dry eye symptoms (P <.0005).

The investigators explain that dry eye is also associated with increased risk of depression and migraine, both of which can affect quality of life.

Limitations of this research include an absence of detailed data on other eye conditions that may carry a large population burden of compromised general vision and the removal of the last 8 questions of the VFQ25. Additionally, more specific DED signs would have provided supplementary insight.

DED “must be adequately diagnosed and treated in both young and old people,” researchers emphasize. “Not only for the wellbeing of the individual patient, but also for society as a whole.”


Morthen MK, Magno MS, Utheim TP, et al. The vision-related burden of dry eye. Ocul Surf. Published online October 28, 2021. doi:10.1016/j.jtos.2021.10.007