The Dry Eye Zone

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Abstract: Dry eye, depression, PTSD

Contrary to what many patients might be thinking (hoping?) when they click on it, this particular study is analyzing depression and PTSD as the chickens rather than eggs in the dry eye coop. But it's very interesting nonetheless.

I don't think I've ever seen a dry eye report on this many people, even the insurance database types. Interesting that nearly as many men as women in this study had a dry eye diagnosis... certainly in line with our anecdotal experiences on DryEyeTalk, and contradicting the conventional position of dry eye being a menopausal women's problem or an old age thing - I love seeing literature debunking this. And I really appreciated that in the conclusions they recommend doctors being (gasp!) proactive about finding out whether people with psychiatric diagnoses have dry eye.

Purpose: To study the scope of dry eye syndrome (DES) in veterans on a national level and to evaluate the relationship between psychiatric diagnoses and DES. 
Design: Case-control study. Setting: Patients were seen in a Veterans Affairs (VA) eye clinic between 2006 and 2011. Patient population: Patients were divided into cases and controls with regard to their dry eye status (cases = ICD-9 code for DES plus dry eye therapy; controls = patients without ICD-9 code plus no therapy).
Main outcome measures: The prevalence of DES and the influence of psychiatric diagnoses on the risk of DES.  
Results: A total of 2 454 458 patients were identified as either a dry eye case (n = 462 641) or control (n = 1 991 817). Overall, 19% of male patients and 22% of female patients had a diagnosis of DES, with female sex imparting an increased risk of DES at each decade compared to male sex (odds ratio [OR] 1.22-2.09). Several conditions were found to increase DES risk, including post-traumatic stress disorder (OR 1.92, 95% CI 1.91-1.94) and depression (OR 1.92, 95% CI 1.91-1.94) (analyses adjusted for sex and age). The use of several systemic medications was likewise associated with an increased risk of DES, including antidepressant medications (OR 1.97, 95% CI 1.79-2.17) and antianxiety medication (OR 1.74, 95% CI 1.58-1.91). Multivariate analysis (adjusted for age and sex) revealed that for psychiatric diagnoses, both the use of medication and the diagnosis remained significant risk factors when considered concomitantly, although the magnitude of each association decreased.
Conclusions: DES is a disease associated with depression and post-traumatic stress disorder, and is prevalent among male and female veterans receiving eye care services. The association could be driven by underlying disease physiology or medications used to treat psychiatric conditions. Regardless of the causal link, this suggests that individuals with a known psychiatric diagnosis should be questioned about dry eye symptoms and, if applicable, referred to an eye care physician.

Am J Ophthalmol. 2012 Apr 26. [Epub ahead of print]

Galor A, Feuer W, Lee DJ, Florez H, Faler AL, Zann KL, Perez VL.

Miami Veterans Administration Medical Center, Miami, Florida; Bascom Palmer Eye Institute, University of Miami, Miami, Florida.

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