Impact of signs and symptoms of dry eye disease on health-related quality of life: a cross-sectional population study among older adults

Purpose To assess the relationship between quality of life (QoL) and ocular surface health within a Finnish population-based cohort. Methods A cross-sectional study involved 601 individuals born between the years 1933-1956. Ocular surface health and dry eye disease (DED) were clinically evaluated using several diagnostic tests. Participants completed the Ocular Surface Disease Index (OSDI), QoL assessment with the 15D and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and the Beck's Depression Inventory (BDI-II) questionnaires. Various statistical methods were employed to explore the associations between QoL, ocular surface health, and sex disparities. Results DED had negative impact on QoL in all participants, and especially in women. Adjusted for comorbidities, DED doubled the odds of worse health-related QoL (15D: OR = 2.31 [95% CI: 1.24-4.31, p < 0.01]) and mental health (SF-36 MCS and BDI-II: OR = 2.08 [95% CI: 1.04-4.16, p < 0.05]). Noninvasive tear break-up time (NIBUT) correlated with all QoL scores. In women, the most significant clinical signs correlating with low QoL were NIBUT (15D: r = 0.20, p = 0.002; SF-36 MCS: r = 0.18, p = 0.026), and conjunctival staining (15D: r=-0.19, p = 0.004; BDI-II: r = 0.27, p < 0.001), whereas in men, blepharitis correlated with depression score (BDI-II: r = 0.20, p = 0.036). High OSDI was associated with worse QoL in women, but not in men. Conclusion This first population-based study assessing general QoL data with objective clinical measures of DED indicated that among elderly population, both symptoms and signs of DED independently impacted different aspects of QoL. In addition, significant sex-differences in these associations were observed and should be considered both in research settings and when assessing and treating people with DED.