Impact of Dry Eye on Visual Acuity and Contrast Sensitivity: Dry Eye Assessment and Management Study

Abstract

Significance: Identification of the association of specific signs of dry eye disease with specific visual function deficits may allow for more targeted approaches to treatment.

Purpose: The purpose of this study was to explore the association of dry eye signs and symptoms with visual acuity (VA) and contrast sensitivity in the Dry Eye Assessment and Management study.

Methods: Baseline data from participants in the Dry Eye Assessment and Management study were used in this secondary cross-sectional analysis. Standardized procedures were used to obtain results on the Ocular Surface Disease Index (OSDI), high-contrast logMAR VA, contrast sensitivity, tear film debris, tear breakup time (TBUT), corneal fluorescein staining, meibomian gland evaluation, conjunctival lissamine green staining, and Schirmer test scores. Generalized linear models that included age, refractive error status, and cataract status were used to assess the association between VA and contrast sensitivity with OSDI score and each dry eye sign. The Hochberg procedure was used to account for multiple comparisons.

Results: Among 487 participants (974 eyes), worse VA was associated with worse mean score on the OSDI vision subscale (39.4 for VA 20/32 or worse vs. 32.4 for VA 20/16 or better; adjusted linear trend, P = .02); scores were not associated with contrast sensitivity. Severe meibomian gland plugging and abnormal secretions were associated with worse mean log contrast sensitivity (1.48 for severe vs. 1.54 for not plugged [P = .04] and 1.49 for obstructed vs. 1.57 for clear [P = .002], respectively). Longer TBUT was associated with better mean log contrast sensitivity (1.57 for TBUT >5 seconds and 1.51 for TBUT ≤2 seconds, P < .0001).

Conclusions: Worse VA rather than worse contrast sensitivity drives vision-related symptoms in dry eye. Greater tear film instability was associated with worse contrast sensitivity.

Trial registration: ClinicalTrials.gov NCT02128763.

Figures

Figure 1.

Flow Chart of Participants for the Analysis Cohorts. Exclusions from the full study group because of different reasons are shown.

Figure 2.

Adjusted mean visual acuity score for signs of dry eye disease associated with visual acuity scores. Greater tear film debris (left) and longer tear breakup time (TBUT; right) were associated with better visual acuity. Letter score of 80 is Snellen 20/25.

Figure 3.

Adjusted mean log contrast sensitivity score for signs of dry eye disease associated with contrast sensitivity. Greater meibomian gland plugging (left) and shorter tear breakup time (TBUT; right) were associated with worse contrast sensitivity.