New research, based on real world data from the international Save Sight Dry Eye Registry, has revealed fresh insights on both the quality-of-life burden of dry eye disease (DED), and the need for individualised treatment strategies.
Published in The Ocular Surface,1 the findings revealed that people with mixed subtype DED (a combination of evaporative and aqueous-deficient DED), corneal neuropathic pain, a history of DED treatment, or past DED-related procedures had significantly worse symptoms, greater activity limitations, and reduced overall quality of life.
Lead author Dr Himal Kandel from the University of Sydney said the results highlight that “DED is more than just a clinical condition – it significantly affects mental health, daily activities, and overall wellbeing”.
DED is more than just a clinical condition – it significantly affects mental health, daily activities, and overall wellbeing
Key Findings
Gender and DED
Women are diagnosed with DED more frequently than men. However, once diagnosed, the quality-of-life impacts are similar across genders.
Impact of DED Subtypes
Patients with mixed subtype DED experienced worse quality of life than those with only evaporative or aqueous-deficient DED alone. The study authors said this suggested that mixed DED “may represent a more advanced disease stage, correlating with greater impairment”.
Correlation Between Signs and Symptoms
The study found clinical signs of DED didn’t necessarily correlate with patient-reported symptoms; some patients with mild signs reported severe symptoms and vice versa. “This underscores the need for independent assessment of both in clinical practice,” the authors said.
Mental Health Impacts
Anxiety-related concerns were more prevalent and bothersome than depression-related issues in the DED population, with the authors concluding that some DED patients may benefit from psychological support.
Visual Acuity and Functional Vision
Worse visual acuity was associated with greater activity limitations.
“However, visual acuity did not correlate with clinical test scores such as tear break-up time or corneal staining. Patients with unstable tear films often report intermittent blurred vision and glare but may still achieve normal visual acuity in controlled test conditions.
“Functional visual acuity assessments, such as spatial contrast sensitivity and reading speed, may provide better measures of DED’s visual impact,” the authors noted.
Corneal Neuropathic Pain
The study found that patients diagnosed with corneal neuropathic pain experienced worse symptoms, greater activity limitations, and poorer mental health compared to those without neuropathic pain.
Patient Questionnaires
The study suggested that the Ocular Surface Disease Index (OSDI), the most commonly used questionnaire for DED, may benefit from validation using modern psychometric methods to ensure it provides accurate assessments of dry eye disease-related quality-of-life impacts.
This study from the international registry has established its role in benchmarking clinical practice and guiding future research.
Holistic Approach
The study emphasised the challenge of improving quality of life in patients with severe or chronic DED, particularly those who have undergone prior treatments or procedures.
And while DED treatments may improve quality of life, the current therapeutic strategies may not fully restore quality of life to pre-DED levels.
“These findings reinforce the need for a holistic approach to DED management,” said co-author Professor Fiona Stapleton AO, from UNSW School of Optometry and Vision Science.
“A comprehensive assessment that includes both signs and symptoms is critical to ensure optimal patient care.”
Senior author Professor Stephanie Watson OAM, Chief Investigator of the Save Sight Dry Eye Registry project, emphasised the significance of this research in advancing real-world evidence on DED.
“This study from the international registry has established its role in benchmarking clinical practice and guiding future research. Longitudinal studies using the Save Sight Dry Eye Registry will further enhance our understanding of treatment effectiveness and patient-centred outcomes.
“As DED continues to be a significant public health concern, studies like this pave the way for more effective, evidence-based management strategies that prioritise patient wellbeing and quality of life improvement”, added Prof Watson.
Reference
- Kandel H, Stapleton F, Watson SL, et al. The impact of dry eye disease on patient-reported quality of life: A Save Sight Dry Eye Registry study. The Ocular Surface. 2025;37:11-23. doi: 10.1016/j.jtos.2025.02.005.
