Dry Eye Limits Work Productivity And Impairs Activity

A middle-aged woman sitting in the kitchen at the glass table
A middle-aged woman sitting in the kitchen at the glass table. Concepts of working at home during quarantine during a coronavirus pandemic
Researchers used a validated survey tool to assess the impact of health problems on work performance and on regular daily activities outside of work.

Dry eye disease (DED) is causing Americans to be less productive at work, according to research presented by investigators affiliated with the Dry Eye Assessment and Management (DREAM) Study Research Group. The investigation, published in Ophthalmology, also shows DED severity is correlated with greater declines in work productivity as well as nonwork activities.

The study indicates that an increase of 10 points on the Ocular Surface Disease Index (OSDI) survey is correlated with an approximate 2% decrease in productivity. Researchers suggest this drop in productivity is due to an increase in both absenteeism and presenteeism (that is, impaired performance during working hours) among patients with DED. The same OSDI increase is associated with a 3.1% increase in activity impairment, the research shows. 

The study included 535 individuals (mean age 58 years, 81% women) at 27 clinical centers in the United States who had moderate to severe DED and were enrolled in the DREAM trial (ClinicalTrials.gov Identifier: NCT02128763) from October 2014 through July 2016. 

Approximately half of the study population (52.2%) was actively employed. Unlike much of the prior research into the social effects of DED, the DREAM investigators included multiple types of ophthalmologic examination, including corneal staining, conjunctival staining, Schirmer testing, tear film break-up time (TBUT), and OSDI scores, in their research. Much of the known research in this area only applied OSDI scores.

In addition to the clinical testing and the OSDI survey, researchers evaluated the participants using the Work Productivity and Activity Impairment (WPAI) questionnaire, a validated 6-question survey designed to assess the impact of health problems on work performance and regular daily activities. The WPAI summarizes the loss of productivity during working hours for health reasons, and the degree of impairment in the performance of regular activities for these health reasons.

The study participants were asked to complete the WPAI and the OSDI at baseline, 3 month, and 6 month follow up visits. Each visit also consisted of a full dry eye clinical examination. The researchers used that data and adjusted for demographics, and comorbidities such as cardiovascular disease, depression, rheumatoid arthritis, diabetes, and others.

In the study, researchers did not find an association between employment status itself and either OSDI score or any of the clinical indices of DED evaluated. With the exception of conjunctival staining, “all DED metrics were associated with decreased work performance and with some level of impairment in carrying out regular activities,” according to the researchers. 

Regarding the clinical testing, the study shows worse TBUT and corneal staining both correlated with increases in presenteeism and impairment of nonwork activities. Worse Schirmer test scores were associated with increased impairment in regular activities, but not work productivity.

Participants experienced mean activity impairment of 24.5%, the study says. Among those employed, the mean score was 2% for absenteeism, 18% for presenteeism, and 19.6% for overall work impairment. 

“The strongest effect on work productivity was found with OSDI, which also was the only DED metric associated with absenteeism, albeit to a lesser extent than with presenteeism. An OSDI score from 0 to 12 generally is interpreted as normal. On average, the OSDI of our patient population, selected with inclusion criteria of moderate to severe DED, was approximately 44,” the researchers explain. “Although clinical signs of DED were associated with work productivity only in cross-sectional analysis, OSDI score maintained a significant association also under a longitudinal analysis of the data, controlling for demographics and comorbidities.”

Disclosure: Multiple study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Greco G, Pistilli M, Asbell PA, Maguire MG, for the Dry Eye Assessment and Management Study Research Group. Association of severity of dry eye disease with work productivity and activity impairment in the dry eye assessment and management study. Ophthalmol. Published online October 14, 2020. doi:10.1016/j.ophtha.2020.10.015