Caring for visually impaired patients is often demanding, both in terms of time and complexity. Patients afflicted by severe vision loss may have advanced ocular disease, uncontrolled systemic disease, require multiple ocular medications, and need co-management with other medical specialties.
As a result, they generally require more chair time. With all these factors to consider, it is plausible, if not likely, that the ocular comfort of these patients may be unintentionally overlooked.
Such oversight could be to the detriment of these patients as dry eye not only causes symptoms of discomfort but also may cause fluctuating vision, decreased contrast sensitivity, higher order aberrations, and overall reduced visual quality.1-4
What was the aim of this study?5
The aim of this study was to better understand the significance of dry eye, meibomian gland dysfunction and blepharitis as co-morbidities in visually impaired patients.
What do the results of this study show?5
The results demonstrate that dry eye is a common co-morbidity in visually impaired patients with the overall prevalence being 38.02%, based on prior diagnosis.
The prevalence of diagnosed meibomian gland dysfunction and blepharitis were 11.90 % and 9.1 % respectively. As expected, the prevalence increased with age (see table 1) and was higher among females (42.47%) as compared with males (31.59%).
Why might this work be important to eye care professionals?
Eye care professionals (ECPs) should be aware that visually impaired patients have a higher prevalence of dry eye compared to the general population, where roughly 8.1% are affected.6
It is important for practitioners to evaluate signs and symptoms of dry eye in visually impaired patients, as the presence of any ocular surface disease may affect ocular comfort and exacerbate visual difficulties.
Understanding the risk of dry eye in the low vision population is imperative, as both dry eye and reduced visual quality are linked to decreased quality of life.7,8
While ECPs should screen all patients for dry eye, a lower threshold for dry eye testing should be considered in patients with glaucoma, history of ocular surgery, diabetes, systemic medications known to cause dry eye, corneal disease or any anatomical abnormalities of the ocular surface or eyelids.
What are the limitations of the work?5
This was a single-site, retrospective analysis that depended on a prior diagnosis of dry eye by an ECP. The study was conducted in Colorado, which is a dry climate that may predispose patients to dry eye more than other locations.
However, when determining prevalence of dry eye, the calculated prevalence is generally lowest when relying on prior diagnoses and highest when based on symptoms. Therefore, the true prevalence of dry eye was likely underestimated in this study.
What further work still needs to be undertaken in this field?
Additional research is needed to compare the prevalence of dry eye in different geographical locations, taking climate into account. A similar study could also investigate the percentage of visually impaired patients suffering from dry eye symptoms.
Conclusion
This study underscores the increased likelihood of dry eye affecting visually impaired patients as compared with the general population. We can surmise that dry eye may be overlooked in our visually impaired patients due to the complexity of their visually needs.
ECPs should bear in mind that dryness in visually impaired patients could not only cause ocular discomfort but also worsen visual outcomes and further reduce quality of life.
Moreover, in cases of diagnosed dry eye, treatment is warranted, as evidence indicates that treating dry eye can improve quality of life.9
- Kaleb Abbott currently works as an assistant professor of ophthalmology at the University of Colorado, USA.
- Full findings were published in: Abbott K, Hanson KS, Lally J. Prevalence of dry eye disease in the low vision population at the University of Colorado. J Optom. Nov 7 2023;17(2): 100501. doi:10.1016/j.optom.2023.100501
References
- Szczotka-Flynn LB, Maguire MG, Ying GS, et al. Impact of Dry Eye on Visual Acuity and Contrast Sensitivity: Dry Eye Assessment and Management Study. Optom Vis Sci. Jun 2019;96(6):387-396. doi:10.1097/opx.0000000000001387
- Koh S. Irregular Astigmatism and Higher-Order Aberrations in Eyes With Dry Eye Disease. Investigative Ophthalmology & Visual Science. 2018;59(14):DES36-DES40. doi:10.1167/iovs.17-23500
- Goto E, Yagi Y, Matsumoto Y, Tsubota K. Impaired functional visual acuity of dry eye patients. Am J Ophthalmol. Feb 2002;133(2):181-6. doi:10.1016/s0002-9394(01)01365-4
- Herbaut A, Liang H, Rabut G, et al. Impact of Dry Eye Disease on Vision Quality: An Optical Quality Analysis System Study. Translational Vision Science & Technology. 2018;7(4):5-5. doi:10.1167/tvst.7.4.5
- Abbott K, Hanson KS, Lally J. Prevalence of dry eye disease in the low vision population at the University of Colorado. J Optom. Nov 7 2023;17(2):100501. doi:10.1016/j.optom.2023.100501
- McCann P, Abraham AG, Mukhopadhyay A, et al. Prevalence and incidence of dry eye and meibomian gland dysfunction in the United States: A systematic review and meta-analysis. JAMA ophthalmology. 2022;
- Miljanović B, Dana R, Sullivan DA, Schaumberg DA. Impact of dry eye syndrome on vision-related quality of life. Am J Ophthalmol. Mar 2007;143(3):409-15. doi:10.1016/j.ajo.2006.11.060
- Khorrami-Nejad M, Sarabandi A, Akbari MR, Askarizadeh F. The Impact of Visual Impairment on Quality of Life. Med Hypothesis Discov Innov Ophthalmol. Fall 2016;5(3):96-103.
- Gomes JA, Santo RM. The impact of dry eye disease treatment on patient satisfaction and quality of life: A review. The ocular surface. 2019;17(1):9-19.