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Impact of Dry Eye on Prolonged Reading

Karakus, Sezen, MD1; Mathews, Priya M., MD, MPH1,2; Agrawal, Devika, BS1; Henrich, Claudia, MD1,3; Ramulu, Pradeep Y., MD, PhD1; Akpek, Esen K., MD1*

doi: 10.1097/OPX.0000000000001303

SIGNIFICANCE Patients with dry eye frequently report difficulty with reading. However, the impact of dry eye on reading has not been studied in detail. This study shows the unfavorable effect of dry eye on reading speed and offers mechanisms that may be responsible.

PURPOSE The purpose of this study was to evaluate the impact of dry eye signs as well as symptoms on both short-duration out-loud and prolonged silent reading.

METHODS This study included 116 patients with clinically significant dry eye, 39 patients with dry eye symptoms only, and 31 controls, 50 years or older. After the Ocular Surface Disease Index (OSDI) questionnaire, objective testing of dry eye (tear film stability studies, Schirmer's test, and ocular surface staining) was performed. Total OSDI score and two subscores (vision related and discomfort related) were calculated. A short-duration out-loud reading test and a 30-minute sustained silent reading test were performed. Reading speed for each test was calculated as words per minute (wpm) and compared across the three groups.

RESULTS Patients with clinically significant dry eye read slower than controls measured with sustained silent reading test (240 vs. 272 wpm, P = .04), but not with short-duration out-loud reading test (146 vs. 153 wpm, P = .47). Patients with dry eye symptoms only did not have slower reading speed measured using either reading test as compared with controls. However, vision-related OSDI subscore independently was associated with slower reading speed (P = .02). Multivariable regression models demonstrated that each 1-point (between 0 and 6) increase in corneal staining score led to a 10-wpm decrease in sustained silent reading speed (P = .01).

CONCLUSIONS This study demonstrates a significant negative impact of dry eye (particularly presence of corneal staining) on prolonged reading. Prolonged reading task may serve as an objective clinically relevant test to measure the impact of dry eye on vision-related quality of life.

1The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland

2Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York

3Department of Ophthalmology, University of Ulm, Ulm, Germany *

Submitted: August 2, 2017

Accepted: July 15, 2018

Funding/Support: Allergan (IIT-00511; to EKA) and Jerome L. Greene Sjögren's Center (to EKA).

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Study Registration Information: IRB NA_00082755.

Author Contributions and Acknowledgments: Conceptualization: SK, CH, PYR, EKA; Data Curation: SK, PMM, DA, CH, PYR, EKA; Formal Analysis: SK, PMM, PYR; Funding Acquisition: EKA; Investigation: SK, DA, CH, PYR, EKA; Methodology: SK, CH, PYR, EKA; Project Administration: SK, DA, CH, EKA; Resources: EKA; Supervision: SK, EKA; Validation: SK, PMM, EKA; Writing – Original Draft: SK, EKA; Writing – Review & Editing: SK, PMM, DA, CH, PYR, EKA.

Presented at the 14th International Sjögren's Symposium; April 21, 2018; Washington, DC.

© 2018 American Academy of Optometry