Original article
The Association Between Dry Eye Disease and Depression and Anxiety in a Large Population-Based Study

https://doi.org/10.1016/j.ajo.2014.11.028Get rights and content

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.

Section snippets

Methods

We performed a retrospective case-cohort study by performing a chart review using the Carolina Data Warehouse of all patients seen in the outpatient setting at the University of North Carolina between July 1, 2008 and June 30, 2013. The study design was prospectively approved by the University of North Carolina Institutional Review Board. The Carolina Data Warehouse is a repository of clinical, research, and administrative data captured from the electronic health records of all patients who

Results

A total of 460 611 patients were included in the analysis; the clinic payer mix was estimated to be 50% Medicare, 25% private insurance, 15% Medicaid, and 10% uninsured. Of the 460 611 patients, there were 7207 patients with dry eye, 20 004 patients with anxiety, and 30 100 patients with depression. Seventy-six patient records were excluded because age could not be determined. Table 1 summarizes the aggregated data. Table 2 presents the prevalence of dry eye in patients with each of depression

Discussion

The purpose of this study was to analyze the association between dry eye disease and each of depression and anxiety. As discussed previously, other studies of these associations had focused on a specific population, such as an elderly population in Beijing or a Veterans Affairs population.17, 18 Our study, however, included over 7000 patients with dry eye across all age groups, which we argue represents a larger and more diverse population than previously studied.

We identified statistically

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