Dry Eye Disease Linked to Impaired Work Functioning

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An analysis of the Lifelines cohort revealed DED had a significant impact on work functioning, comparable to the impact of other chronic diseases considered function impairing.

A new study examining the link between dry eye disease (DED) and work functioning indicated a similar burden to other chronic diseases considered function impairing, highlighting the importance of recognizing the disease as a severe disorder.1

In the analysis, DED was associated with an increased risk of unemployment, above-average work absenteeism, worry about job loss, and impaired work function. Part of the increased risk was attributed to various medical comorbidities by investigators, including chronic pain disorders.

“Clinicians, employers, and the general public should be better informed about dry eye’s impact on work functioning, and it should be emphasized that dry eye is a serious disorder that requires timely diagnosis and treatment,” investigators wrote.1

A team led by Jelle Vehof, Department of Ophthalmology, University of Groningen, University Medical Center Groningen, conducted the first large epidemiological study using the Dutch population-based Lifelines cohort to better define the relationship between DED and various work-related factors. Due to the size of the study, the analysis allowed correction for 48 comorbidities of dry eye, as well as stratification for the population on age, sex, use of artificial tears, and presence of a clinical diagnosis of DED.

According to investigators, the identification of underlying factors of the relationship between DED and work functioning may further elaborate the impact of DED on patients' lives and provide strategies for improving working life. The analysis included 32,475 participants and detected an odds ratio (OR) of 1.11 or higher of having impaired work functioning in dry eye subjects.

The Women’s Health Study (WHS) dry eye questionnaire was used by investigators to assess DED, while work functioning was assessed with the Work Role Functioning Questionnaire 2.0. Study participants were defined as having DED if they reported having a clinical diagnosis of DED, or had dryness and irritation either “often” or “constantly’. Investigators assessed the relationship between DED and work measures using logistic regression models, correcting for variables including age, sex, body mass index (BMI), income, education level, and smoking.

Overall, 71,067 subjects were included in the study and 60% were female. Of the population, 8.3% were classified as having WHS-defined DED and highly symptomatic dry eye was found in 1.7% of participants. Results from the Work Role Functioning Questionnaire indicate the mean overall work functioning score was 86.6 out of 100.

Subjects with DED were indicated to have a greater association with DED and unemployment, above-average work absenteeism, and worry about job loss. After correcting for age, sex, BMI, education level, income, smoking history, and 48 possible confounding comorbidities, investigators found absenteeism and worry about job loss remained significantly increased (OR, 1.16; P = .01 and OR, 1.22; P <.0005, respectively).

Moreover, they reported individuals with dry eye had a higher prevalence of impaired overall work functioning, at 49.2% compared to 41.1% in controls (OR, 1.43; P <.0005 corrected for age and sex). Data show 59.1% of individuals with highly symptomatic dry eye had impaired overall work function. Both higher education and a clinical diagnosis protected against impaired work functioning (all P = .03).

The extensive data collection in the Lifelines cohort allowed direct comparison between various chronic diseases’ impacts on work functioning, according to investigators. When compared to other chronic diseases, DED showed a comparable risk of impaired work functioning to rheumatoid arthritis, known for decreasing work functioning, while highly symptomatic dry showed a comparable risk to depression.

“This study highlights that DED necessitates attention on a par with over severe chronic disorders,” investigators wrote.1

1. Morthen MK, Magno MS, Utheim TP, Hammond CJ, Vehof J. The work-related burden of Dry Eye. The Ocular Surface. 2023;28:30-36. doi:10.1016/j.jtos.2023.01.006