Study design and baseline findings from the progression of ocular findings (PROOF) natural history study of dry eye

Peter J McDonnell, Stephen C Pflugfelder, Michael E Stern, David R Hardten, Taryn Conway, Linda Villanueva, David A Hollander, Peter J McDonnell, Stephen C Pflugfelder, Michael E Stern, David R Hardten, Taryn Conway, Linda Villanueva, David A Hollander

Abstract

Background: The aim of this research is to initiate a 5-year natural history study of dry eye disease (DED) using objectively assessed and patient-reported outcomes, to explore the hypothesis that DED is a progressive condition that has substantive and measurable impacts not only on the ocular surface, but on quality of life and visual functioning. Our objective for this report is to examine the baseline data.

Methods: A multicenter, prospective, controlled, observational study of Level 2 (mild-to-moderate) DED patients based on International Task Force Delphi Panel severity grading, and controls, documented baseline measures (including tear film biomarkers and quality of life). Tear cytokine concentrations were also measured in the tear film. Patients were using artificial tears as needed.

Results: Two hundred seventeen DED patients and 67 gender- and age-matched controls were enrolled. A majority were females and Caucasian and groups did not differ significantly in terms of gender, race, or age. Differences between DED and matched controls, at baseline, included mean scores for Ocular Surface Disease Index (31.7 vs 4.1, P < 0.0001), Schirmer test (5.7 vs 15.3 mm, P < 0.0001), corneal staining (1.4 vs 0.2, P < 0.0001), conjunctival staining (1.4 vs 0.3, P < 0.0001), and tear break-up time (5.7 vs 8.5 s, P < 0.0001). Tear cytokines levels were determined and included interferon-γ, interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, tumor necrosis factor-α, epidermal growth factor, IL-13, IL-17, IL-1α, and inducible protein-10. The mean levels of IL-8 and IL-6 were slightly higher in the DED group at baseline. Blurred vision was reported as moderate/severe/very severe at baseline in 57.6% of DED patients vs.10.5% of normal controls (P < 0.0001). DED patients reported greater reductions in work and non-work productivity, as well as greater need for visits to ophthalmologists during the prior year.

Conclusions: In this report of the baseline findings of a 5-year natural history study of DED, a striking disease burden is observed with regard to blurred vision, productivity, and visits to eye care practitioners in mild to moderate DED patients compared to normal subjects of similar ages and genders.

Trial registration: ClinicalTrials.gov NCT00833235 on January 30, 2009.

Keywords: Cytokines; Dry eye disease; Natural history; Tear break-up time; Tear film biomarkers.

Conflict of interest statement

Competing interests

McDonnell is a board member of Allergan, Pflugfelder is a consultant to, and has received research funds from Allergan. Hardten received support from Allergan. Conway is an employee of Allergan. Villanueva, Hollander and Stern were employees of Allergan at the time the study was conducted; Stern left Allergan in April 2015. All authors met the ICMJE authorship criteria. Neither honoraria nor payments were made for authorship.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

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Fig. 1
Geographic location of clinical investigators

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