Severe Dry Eye impacts Quality of Life Scores Similar to Chronic Angina

I have asked many of my severe dry eye patients if they would prefer to have chronic chest pain, need hospital dialysis or continue to have their dry eye discomfort and pain. All of them said they would prefer one of the other options. While this is not a scientific study by any means, and these patients have not had chronic angina or need dialysis to which to compare their pain, the below study sheds light into the debilitating, chronic, miserable pain,  dry eyes can cause in one's life.

These severe dry eye patients feel their eyes more than 50% of their life (at least a 5/10 pain score). Many of them wake up at night time from the dry eyes they feel. Many of them really have a hard time going into stores or even going to work because of increased discomfort from the light and even perfumes that irritate the eyes.  Sometimes they do not even want to socialize as it hurts their eyes to talk too much or they are tired of being asked by they blink so much or close their eyes so much

What I do not understand is why insurance companies do not cover dry eye care enough. It is outrageous that they do not cover even proven treatments, such as the Lipiflow, IPL, or Meibomian Gland Probing, when we know not having such treatments can lead to future meibomian gland loss, worsening dry eyes, and debilitating pain.

It is important for insurance and families and especially parents of children who give their children a cell phone, computer or video game (which is really "ignorance leading to long term misery and pain for your child": see https://www.youtube.com/watch?v=7R265A4IsNk. A colleague recently told me that giving a child an electronic device was really child abuse. I said that was too strong a statement, but I know what he means. When we see these kids being sent to us for a Corneal Transplant evaluation, we are horrified to hear they were given their own cell phone or ipad when they were 4 or 5 or 6 or that they play video games 2-3 hours a day. We can only imagine how the electronic devices have entranced these kids to alter blinking rates and ignore their eye's screaming out, "Look away! Blink! I am dying!"

I know parents, loved ones, friends, and teachers do not mean to hurt their children and only want to help their kids succeed in this world, but giving a young child an electronic device unsupervised is worse than crack cocaine in my opinion as crack is rare and hard to get and rarely causes chronic daily severe pain. Electronics are all around us, are incredibly addictive, and have devastating, life altering risks.

Sandra Lora Cremers, MD, FACS

Ocul Surf. 2006 Jul;4(3):155-61.

Utility assessment to measure the impact of dry eye disease.

Buchholz P1, Steeds CS, Stern LS, Wiederkehr DP, Doyle JJ, Katz LM, Figueiredo FC.

Author information

Abstract

Utility assessment is a formal method for quantifying and understanding the relative impact of a given health state or disease on patients. In this article, methodology of utility assessment is explained and illustrated, and results of an original study are reported. The study was conducted to determine utility values (patient preferences) associated with dry eye disease and compare them to other disease utilities, as well as to compare patient and physician assessments of disease. Forty-four patients in the United Kingdom with moderate to severe dry eye were surveyed via interactive utility assessment software. Utility values were measured by the Time Trade-Off (TTO) and Standard Gamble (SG) methods and adjusted to scores from 1.0=perfect health to 0.0=death. Patients reported utilities for: self-reported current dry eye status, self-reported current comorbidities, various dry eye severities, and binocular and monocular painful blindness. Patient's dry eye severity was independently classified by patient and physician assessments. Correlation analyses (Pearson) were performed between patients' current dry eye utilities and the physician-assessed severity. Agreement between self-reported and physician-reported patient severity was analyzed (Kappa). Patients reported higher utilities for their current dry eye condition than for monocular and binocular blindness (SG:0.84>0.60>0.51; TTO:0.67>0.43>0.38). Using TTO, the mean score for asymptomatic dry eye (0.68) was similar to that for "some physical and role limitations with occasional pain" and severe dry eye requiring surgery scored (0.56) similarly to hospital dialysis (0.56-0.59) and severe angina (0.5). Utilities described for scenarios of dry eye severity levels were slightly higher for patients self-reported as mild-to-moderate versus those self-reported as severe. For current dry eye condition, mean utilities for these groups were 0.72 for self-reported mild-to-moderate and 0.61 for self-reported severe. Utilities for dry eye were in the range of conditions accepted as lowering health utilities. Severe dry eye utilities were similar to those reported for dialysis and severe angina, highlighting the impact of dry eye disease on patients.