Smartphone App Spots Undiagnosed Symptomatic Dry Eye, Helps Identify Risk Factors

By Reuters Staff

December 05, 2019

NEW YORK (Reuters Health) - A smartphone app can identify people with undiagnosed symptomatic dry eye and identify factors linked with the condition, according to a new crowd-sourced study.

"We identified risk factors possibly associated with undiagnosed symptomatic dry eye, including younger age, male sex, and absence of collagen disease, mental illnesses, ophthalmic surgery, and history of contact lens use," Dr. Takenori Inomata of Juntendo University Faculty of Medicine in Tokyo and colleagues write in JAMA Ophthalmology, online November 27.

"This study may lead to further understanding of dry eye symptoms and identify at-risk individuals who should be clinically evaluated, potentially improving prevention or early treatment of dry eye disease," they add.

Dry eye is on the rise as the world ages and use of digital devices climbs, and people face "an increasingly stressful social environment," the authors note. "Smartphone applications are expected to play a substantial role in self-help interventions for dry eye disease screening."

The authors designed the DryEyeRhythm app using Apple's ResearchKit. The study includes data from November 2, 2016, when they released the app, through January 12, 2018, and includes more than 4,400 users from across Japan.

Two-thirds of the participants were women, with a mean age of 27.9 years. There were 3,294 individuals (74.0%) with symptomatic dry eye and 1,160 (26.0%) without symptomatic dry eye.

Among individuals with symptomatic dry eye, 27.3% had been diagnosed and the rest were undiagnosed.

Risk factors for symptomatic dry eye included being younger (odds ratio, 0.99), female sex (OR, 1.99), pollinosis or hay fever (OR, 1.35), depression (OR 1.78), mental illness not including depression or schizophrenia (OR, 1.87), current contact lens use (OR, 1.27), extended screen time (more than eight hours a day, OR, 1.55), and smoking (OR, 1.65).

Factors significantly associated with being undiagnosed included younger age (OR, 0.96), male sex (OR, 0.55), absence of collagen disease (OR, 0.23), mental illness not including depression or schizophrenia (OR, 0.50), ophthalmic surgery not including cataract surgery or laser-assisted in situ keratomileusis (OR, 0.41), current contact use (OR, 0.64), and past contact use (OR, 0.45).

"In the context of dry eye disease, the present study suggests that dry eye disease in younger men without collagen disease, mental illnesses, ophthalmic surgery, and history of contact lens use may remain undiagnosed," Dr. Inomata and colleagues write. "To reduce the burden of dry eye disease in the community, greater awareness is needed for this particular patient group with undiagnosed symptomatic dry eye."

Despite growing recognition of dry eye disease, scientific evidence on associated risk factors and health behaviors remains scarce, Dr. Michael T. M. Wang of New Zealand National Eye Centre at The University of Auckland and colleagues note in an editorial accompanying the study.

"The investigation of risk factors associated with symptomatic dry eye and undiagnosed disease in the current study offers a valuable first step and, as noted by Inomata et al, highlights the potential of mobile health technology in future dry eye epidemiologic research," they conclude.

The study was funded by several companies, including Alcon Japan Ltd.


JAMA Ophthalmol 2019.