Dry eye disease severity and impact on quality of life in type II diabetes mellitus

Abstract

Dryness of the eyes is the most common ocular symptom of diabetic patients which is often ignored by health care professionals. Aim: To assess the severity of DED, its impact on QoL ( OSDI), and the grade of anterior ocular surface damage in patients with T2 DM in comparison to healthy controls. Methods and materials: Our study included 2 groups: a study (n = 46)–patients with T2 DM and DED (mean age = 63.8 ± 6.7 years) and a control (n = 26) (mean age = 67.9 ± 8.9 years). DED was diagnosed and graded using the modifi cation of the International Task Force severity grading scheme (dry eye severity grading scheme) as recommended by DEWS 2007, Efron grading scale, Oxford Scheme. Health-related quality-of-life ( QoL) was evaluated by Ocular Surface Disease Index– OSDI according to the consensus recommendation of TFOS DEWS II. The statistical package STATISTICA v.10.0. Results: 54% of patients in the study group suff ered from mild DED according to the OSDI score; in contrast, 58% of controls did not experience the disease. There were no patients with severe DED. Diabetic neuropathy is a potential factor reducing corneal sensitivity which may contribute to the lower OSDI scores in patients with long duration of T2 DM (median = 9 years, range 1–27 years). Health-related QoL was signifi cantly diff erent in the study and control group (p = 0.00000). Mean OSDI in the study group is 25.14 ± 3 for patients with keratopathy and 19.3 ± 3.5 for those without corneal injury (p = 00.000002). About 70 % of patients in the study group had a signifi cantly diff erent mean OSDI score in comparison to controls without keratopathy, suggesting lower QoL in T2 DM patients. Based on DEWS scheme, 11 patients from the control group did not have DED. Grade I severity level was found in 46 % controls and 33 % of patients with T2 DM. Grade II was detected predominantly among the study group. We also found a positive correlation between the OSDIscore and DEWS grade (r = 0.705; p = 00.000000) in the study group and a negative correlation with Shirmer test and TBUT. Oxford scale showed that the 63 % of diabetic patients had grade I, 22 %-grade II, 1 patient-grade III. In the control group–grade I was found in 7.7 % of patients. 88.5% of the control group and 13% of the study group did not have pathological patterns associated with conjunctival redness (p = 0.0001). Conclusions: Dry eye disease is associated with lower quality of life among type 2 diabetic patients with and without keratopathy in comparison to healthy controls.