Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
Klintaps College of Health and Allied Sciences, Tema, Ghana.
PLoS One. 2023 Mar 24;18(3):e0283597. doi: 10.1371/journal.pone.0283597. eCollection 2023.
To ascertain the presence of Dry Eye Syndrome (DES) in patients being treated for glaucoma, using subjective and objective methods and to examine DES impact on their quality of life (QOL).
A cross-sectional study was conducted by employing 156 glaucoma patients recruited from treatment centers in the Cape Coast Metropolis in Ghana. All the participants underwent dry eye examination and completed the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ), the Dry Eye-related Quality of Life Score (DEQS) and the Ocular Surface Disease Index (OSDI). Comparisons of the clinical tests, NEI VFQ-25 subscale item and composite scores and scores of DEQS and OSDI were made among subgroups divided according to the presence of dry eye symptoms or signs. Multivariate logistic regression analysis was performed to investigate the factors that influence DES related-QOL among the patients.
The study involved 156 subjects with a mean age of 47.88 ± 16.0 years and made up of 81 (51.9%) females and 75 (48.1%) males. A One-Way ANOVA was conducted, and the F-statistic (F) indicated that there was a significant difference in the mean scores of the groups. There were significantly lower Tear break-up time (TBUT) values found in the group with definite dry compared with the group without DES and the group that was symptomatic with no signs DES in both eyes, [(F(3,151) = 13.703, p<0.001 (RE): (F(3,152) = 18.992, p<0.001 (LE)]. Similar results were found for Schirmer test (ST) [(F (3,151) = 28.895, p<0.001 (RE): (F (3,152) = 17.410, p<0.001 (LE)]. There was statistically significant difference in the mean composite score (64.93 ± 20.27) for the NEI VFQ-25 and sub-scale score of ocular pain, which was significantly lower in the group with definite dry as compared to other sub-groups (F(3,152) = 4.559, p = 0.004). OSDI scores of the group with definite dry eye (47.69-19.17) and the group that was symptomatic but with no signs (38.90-22.44) were significantly higher than those without dry eye and those that were asymptomatic but had a sign (F(3,152) = 17.896, p<0.001), with a similar trend occurring in the groups with relation to DEQS scores (F(3,152) = 8.775, p<0.001). There was a strong correlation between the DEQS and the OSDI questionnaires, and a weak correlation between the DEQS and the NEI VFQ-25 questionnaire after adjusting for all other factors (all p < 0.01).
The study established a high presence of DES and consequently low DES related-QOL in glaucoma patients. Dry eye questionnaires are able to discriminate those who have definite dry eye from the other groups, showing its appropriateness for clinical use in glaucoma patients. Ocular surface evaluation should be conducted among glaucoma patients on topical anti-glaucoma therapy to ensure the timely detection and treatment of signs and symptoms of DES and improvement of dry-eye related QOL.
使用主观和客观方法确定接受青光眼治疗的患者是否患有干眼症（DES），并检查 DES 对其生活质量（QOL）的影响。
采用横断面研究，从加纳 Cape Coast 大都市的治疗中心招募了 156 名青光眼患者。所有参与者均接受干眼检查，并完成了 25 项国家眼科研究所视觉功能问卷（NEI-VFQ）、干眼相关生活质量评分（DEQS）和眼表面疾病指数（OSDI）。根据是否存在干眼症状或体征，对根据干眼症状或体征存在与否进行分组的亚组进行临床检查、NEI VFQ-25 子量表项目和综合评分以及 DEQS 和 OSDI 评分的比较。采用多元逻辑回归分析探讨影响患者 DES 相关 QOL 的因素。
本研究共纳入 156 名平均年龄为 47.88 ± 16.0 岁的受试者，其中女性 81 名（51.9%），男性 75 名（48.1%）。进行了单因素方差分析，F 统计量（F）表明各组的平均得分存在显著差异。与无 DES 组和双眼无症状无体征 DES 组相比，确诊干眼组的泪膜破裂时间（TBUT）值明显较低，[F（3,151）=13.703，p<0.001（RE）：（F（3,152）=18.992，p<0.001（LE）]。Schirmer 测试（ST）也有类似的结果，[F（3,151）=28.895，p<0.001（RE）：（F（3,152）=17.410，p<0.001（LE）]。NEI VFQ-25 综合评分（64.93±20.27）和眼痛亚量表评分存在统计学显著差异，与其他亚组相比，确诊干眼组的评分明显较低，[F（3,152）=4.559，p=0.004]。确诊干眼眼（47.69-19.17）和有症状但无体征（38.90-22.44）的 OSDI 评分明显高于无干眼和无症状但有体征的患者，[F（3,152）=17.896，p<0.001]，DEQS 评分的组也有类似的趋势，[F（3,152）=8.775，p<0.001]。在调整所有其他因素后，DEQS 和 OSDI 问卷之间存在很强的相关性，DEQS 和 NEI VFQ-25 问卷之间存在弱相关性（均 p<0.01）。
该研究确定了青光眼患者中存在较高的 DES，因此 DES 相关的 QOL 较低。干眼问卷能够将确诊干眼症患者与其他组区分开来，表明其适合在青光眼患者中进行临床应用。在接受局部抗青光眼治疗的青光眼患者中应进行眼表面评估，以确保及时发现和治疗 DES 的症状和体征，并改善干眼相关 QOL。
