Racial and Ethnic Differences in the Association Between Diabetes Mellitus and Dry Eye Disease.

Purpose:To examine the association between dry eye and diabetes mellitus among a large North Carolina patient population. Methods:A retrospective cross-sectional study of patients seen within the University of North Carolina medical system between July 1, 2008, and September 1, 2017, was performed. De-identified medical records contained within the Carolina Data Warehouse of adult patients who have had an ocular evaluation were studied. Four categories of disease states were identified by ICD-9 and ICD-10 codes. Patients were grouped based on being diagnosed with Dry Eye Disease (ICD-9: 375.15, 370.33, and ICD-10: H04.12, H16.221), Diabetes Mellitus (ICD-9: 250.00-250.93 and ICD-10: E08-E11, E13), neither, or both diseases. Odds ratios of the association between diabetes and dry eye were calculated for the following racial/ethnic groups: Non-Hispanic White, Non-Hispanic Black/African American, Asian, and Hispanic. Results:A total of 81,480 patients were included in the analysis; of those, 8978 patients had dry eye disease and 18,361 patients had diabetes. The remaining 54,141 patients had neither disease. Dry eye prevalence among patients with diabetes was 14.39% (95% CI: 13.89-14.91%) and 10.11% (95%CI: 9.88-10.35%) among patients without diabetes. The odds of a patient with diabetes having dry eye are 1.15 (95% CI: 1.09-1.21) times that of a patient without diabetes. Asian patients with diabetes demonstrated the highest odds of having dry eye at 1.49 (95% CI: 1.12-1.98). Conclusions:Dry eye is common among patients with diabetes, and the association between these diseases is strongest among Asian patients. Race and ethnicity are important demographic factors that may guide providers in the diagnosis and treatment of dry eye in the setting of diabetes.

The association between dry eye disease and depression and anxiety in a large population-based study.

PURPOSE: To investigate the association between dry eye disease and each of depression and anxiety. DESIGN: Retrospective, case-control study. METHODS: setting: University of North Carolina outpatient clinics. study population: All patients over the age of 18 years seen between July 2008 and June 2013 were included in the analysis. observation procedure: Cases were defined according to ICD-9 diagnosis codes for dry eye disease, anxiety, and depression. outcome measure: Separate odds ratios were calculated for dry eye disease and each of anxiety and depression. Similar odds ratios were also calculated between dry eye disease and rheumatoid arthritis, a systemic disease with a known association with dry eye, as a way of validating our approach. RESULTS: A total of 460 611 patients were screened; 7207 patients with dry eye were included, while 20 004 patients with anxiety and 30 100 patients with depression were included. The adjusted odds ratio for dry eye disease and anxiety was 2.8 (95% confidence interval [CI] 2.6-3.0). For dry eye disease and depression, the odds ratio was 2.9 (95% CI 2.7-3.1). CONCLUSIONS: We identified a statistically significant association between dry eye disease and each of depression and anxiety. Such an association has implications for ophthalmologists in the management and treatment of dry eye disease.

Instrument development of the UNC Dry Eye Management Scale.

PURPOSE: Dry eye disease (DED) is a common ocular disease that can have adverse effects on quality of life. Our aim was to develop a single-item questionnaire that is reliable, patient-driven, and clinic friendly to assess DED symptoms and their effect on quality of life to help support the management of patients with DED. METHODS: An initial dry eye questionnaire was created and administered to 18 patients with DED followed by a 15-minute cognitive interviewing session. This questionnaire was then refined using feedback obtained from the cognitive interview and was termed the University of North Carolina Dry Eye Management Scale (UNC DEMS). Field testing was then performed on 66 patients (46 with DED and 20 without DED) to determine the validity and test-retest reliability of the UNC DEMS compared with the current gold standard, the Ocular Surface Disease Index (OSDI). Pearson correlation coefficients were calculated between the UNC DEMS, OSDI, and other DED measures to assess criterion-related validity. Reliability coefficients were estimated for test-retest reliability. RESULTS: Comparing the UNC DEMS with the OSDI across all study participants, the correlation coefficient was 0.80 (P < 0.001). Comparing the UNC DEMS with the OSDI in the DED group, the correlation coefficient was 0.69 (P < 0.001). The test-retest reliability coefficient of the UNC DEMS was estimated to be 0.90. CONCLUSIONS: The UNC DEMS is a valid, reliable questionnaire that can be efficiently administered in a busy clinical practice and can be used to support the management of patients with DED.