Economic Burden and Loss of Quality of Life as a Consequence of Dry Eye Syndrome
Canadian authors evaluated the direct and indirect financial costs associated with dry eye syndrome (DED − dry eye disease) and the impact of this condition on the quality of life (QoL) of patients. The results were stratified according to the severity of the condition. The most significant was the loss of work productivity, highlighting the need for adequate solutions for DED.
Impacts of DED and treatment options
DED is a multifactorial disease with disturbances of the periocular tear film, associated with significant discomfort and can lead to damage to the eye surface. Worldwide prevalence ranges from 5 to 50%, with an estimate of 21% in Canada.
The Dry Eye Workshop (DEWS) of the Tear Film and Ocular Surface Society (TFOS − Tear Film and Ocular Surface Society) recommended a stepwise approach with monitoring symptoms and signs of DED and treating other eye surface disorders. Initially, eye lubricants are administered, and if their effect is insufficient, topical antibiotics, corticosteroids, secretagogues, or immunomodulatory drugs are recommended. Other options include serum eye drops, therapeutic contact lenses, oral secretagogues, or occlusion of the ductus lacrimalis.
It is known that DED has a significant economic impact, including both direct costs for prescribed or over-the-counter medications and indirect costs in the form of lost work productivity.
Cross-sectional study
A more precise evaluation of the economic costs and QoL deterioration associated with DED was the goal of a prospective observational cross-sectional study conducted in 6 optometric and ophthalmologic centers in Canada. Patients aged 18–64 years diagnosed with DED by a physician, who had symptoms for at least 1 year, and regularly visited a doctor due to DED were included.
Participants underwent a 20-minute survey covering demographic data, overall health status, DED intensity based on the EDS VAS score (Eye Dryness Score − Visual Analog Scale with a scale of 0–100, where a score < 40 indicates mild, 40‒59 moderate, and ≥ 60 severe DED), QoL based on the NEI VFQ 25 questionnaire (National Eye Institute Visual Function Questionnaire), direct economic costs (use of healthcare and patient spending on eye lubricants, cyclosporine, dietary supplements, tear duct plugs, visits to optometrists and ophthalmologists in the past 3–24 months) and indirect costs (sick leave and underperformance at work according to the Work Productivity and Activity Impairment survey).
The study had two primary endpoints − direct and indirect economic costs associated with DED and the impact of DED on QoL. A sub-analysis was also conducted in subgroups according to DED intensity, including a subgroup with Sjögren's syndrome.
Assessed population
Data from 146 patients with an average age of 49.8 years, 89.7% of whom were women, were analyzed. Employment was held by 65.1% of the participants. Only 13.7% of patients used contact lenses, but 82.3% spent > 3 hours daily in front of a screen, and 24.7% > 7 hours. Moderate DED was present in 19.2%, severe DED in 69.2%, and Sjögren's syndrome in 8.2% of the participants. The most common ophthalmological comorbidity was seasonal allergic conjunctivitis (21.9%) and Meibomian gland dysfunction (18.5%).
Economic costs and impact on quality of life
The total average annual costs associated with DED amounted to 24,331 Canadian dollars (CAD) per patient, of which 79.3% were indirect costs due to reduced work productivity (21,052 CAD). Annual costs increased with the severity of DED: indirect costs were 5,961 CAD for mild DED, 16,525 CAD for moderate DED, and 25,485 CAD for severe DED, direct costs were 958 CAD, 1,303 CAD, and 2,766 CAD respectively.
Severe DED was associated with a lower average QoL score (72.42) compared to moderate DED (86.60) and mild DED (89.55). The lowest average QoL score was among patients with Sjögren's syndrome (59.81). Eye pain had the greatest impact on QoL. DED also adversely affected mental health, role performance at work and other activities, and driving ability.
Conclusion
This observational study provides additional data confirming the significant socioeconomic impact of dry eye syndrome and its adverse effect on patients' quality of life. The largest share of economic costs for Canadian patients with DED is indirect costs mainly due to lost work productivity. The severity of the disease correlates with both direct and indirect economic costs and the impact on QoL.
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Source: Chan C., Ziai S., Myageri V. et al. Economic burden and loss of quality of life from dry eye disease in Canada. BMJ Open Ophthalmol 2021; 6 (1): e000709, doi: 10.1136/bmjophth-2021-000709.
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