Transcript Click to add title - WCC VI 2010

Association between
Depression And Dry eye
Sang Beom Han, MD,1 Joon Young Hyon, MD,1 Young Joo Shin, MD,1
Won Ryang Wee, MD,2 Jin Hak Lee, MD,1
1
Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
2 Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
Financial Disclosure: None
Background

As in other diseases, dry eye symptom can possibly be affected by the
psychological factors, such as, depression and stress, and anxiety.

It has also been suggested that the sicca symptoms in patients with dry
eye and mouth syndrome may be of psychosomatic origin.
Mariette et al. Rheumatology 2003;42:914-915

The discrepancy between dry eye signs and symptoms also suggests
the influence of psychologic factor on the perception of ocular dryness.
Lin et al. Invest Ophthalmol Vis Sci 2005;46:1593-1598

However, there is few reports about the relationship between dry eye
and depression, whereas many previous studies have shown that
depressive mood can be an important causes of oral sicca symptom.
Anttila et al. Psychosom Med 1998;60:215-218
Bergdahl et al. J Dent Res 2000;79:1652-1658
Purpose

To determine the association between depressive mood
and dry eye in elderly Korean population.
Material and Methods


As a part of the Yongin Aging Study (YAS)
YAS
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population-based longitudinal cohort study on the memory, mood,
and sensory functions of Korean elders aged 65 years or older.
Conducted from May 2008 to February 2009 in Yongin
Among the 1,060 elderly subjects randomly selected, 657 agreed to
participate in this study.
Initial Field study

Evaluation for Dry Eye
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Schirmer test
Dry Eye Questionnaire (DEQ)
During recent 2 weeks
1.Do your eyes feel dry?
2.Do you feel gritty or sandy sensation in your eyes?
3.Do your eyes ever have a burning sensation?
4.Do your eyes ever feel sticky?
5.Do your eyes ever feel watery or tearing?
6.Are your eyes ever red?
 Allowed responses were
‘none”, ‘rarely’, ‘sometimes’,
and ‘often or all the time’.
 Dry eye was defined as
 having one or more symptoms often or all the time.

Psychologic evaluation
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Cognitive function
 Mini-Mental Status Examination in the Korean Version of the CERAD
Assessment Packet (MMSE-KC), a item questionnaire to screen dementia.
•
Depressive mood
 Korean version of the Short Geriatric Depression Scale (SGDS-K), a 15-item
questionnaire (score per item 0 or 1) developed for screening of major depression.
 A score of 8 as optimal cutoff score of SGDS-K.
Bae et al. J Psychosom Res 2004;57:297-305
Further Evaluation for Dry Eye



Tear film breakup time (BUT) test
Fluorescein stain
Examination of meibomian gland dysfunction

Positive signs were defined as
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Tear film BUT ≤10 seconds
Schirmer test score ≤ 5 mm
Fluorescein score ≥ 1
or the presence of meibomian gland disease
In each subject, the worse eye was used for analyses.
Results

Total 657 subjects
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Mean age was 72.0 ± 5.9 years (mean ± SD, range 65-95)
M : F ratio was 48.2%: 51.8% (317 : 340).
198 (30.3%) met the diagnostic criteria for dry eye, define as
presence of ≥ 1 of the 6 dry eye symptoms.
SGDS-K questionnaire was finished in 650 participant, and 148
(22.8%) met the diagnostic criteria for major depression, define as
having SGDS-K score of ≥8.
MMSE-KC questionnaire was completed in 656.
Schimer test was done in 648 participants.
139 subjects completed the further evaluation for dry eye.
SGDS-K and MMSE-KC scores according to the
presence or absence of dry eye symptoms
SGDS-K (for Depression)
Variables
MMSE-KC (for Dementia)
N
Score
(Mean ± SD)
P value
N
Score
(Mean ± SD)
P value
123
527
5.15 ± 4.40
4.08 ± 3.98
0.015
124
532
24.46 ± 4.30
24.08 ± 4.87
0.383
68
582
6.24 ± 4.52
4.05 ± 3.97
<0.001
69
587
23.49 ± 4.70
24.22 ± 4.77
0.228
32
618
5.69 ± 4.21
4.21 ± 4.07
0.060
33
623
24.03 ± 3.80
24.15 ± 4.82
0.858
56
594
6.82 ± 4.84
4.04 ± 3.93
<0.001
56
600
24.00 ± 4.91
24.16 ± 4.76
0.814
106
544
5.91 ± 4.61
3.97 ± 3.90
<0.001
107
549
23.77 ± 4.79
24.22 ± 4.77
0.368
45
605
6.02 ± 4.50
4.15 ± 4.02
0.009
45
611
25.11 ± 4.37
24.08 ± 4.80
0.134
198
452
5.53 ± 4.48
3.73 ± 3.77
<0.001
199
457
24.07 ± 4.66
24.18 ± 4.81
0.784
Dry eye symptom Questionnaire
Question 1
Positive
Negative
Question 2
Positive
Negative
Question 3
Positive
Negative
Question 4
Positive
Negative
Question 5
Positive
Negative
Question 6
Positive
Negative
Dry Eye Disease
Yes
No
SGDS-K and MMSE-KC scores according to the
presence or absence of dry eye signs
SGDS-K
Variables
MMSE-KC
N
Score
(Mean ± SD)
P value
N
Score
(Mean ± SD)
P value
175
467
4.06 ± 4.08
4.37 ± 4.08
0.400
175
472
24.45 ± 4.31
24.03 ± 4.90
0.297
BUT
≤10 sec
>10 sec
119
20
3.68 ± 3.82
4.30 ± 3.98
0.523
119
20
25.92 ± 3.07
25.25 ± 3.19
0.394
Fluorescein score
≥1
=0
50
89
3.96 ± 3.90
3.66 ± 3.82
0.665
50
89
25.66 ± 2.99
26.10 ± 3.27
0.437
Meibonian gland disease
Present
Absent
72
67
3.89 ± 3.79
3.64 ± 3.91
0.706
72
67
25.81 ± 2.81
25.84 ± 3.38
0.954
Dry eye signs
Schirmer I test
≤5 mm
>5mm
Frequency of positive dry eye symptoms and signs
according to the presence or absence of major depression
No (%)
Variables
P value
Odds Ratio
(95% CI‡)
SGDS-K ≥ 8
SGDS-K < 8
Question 1 positive†
37 / 148 (25.0%)
86 / 502 (17.1%)
0.032
1.61 (1.04 – 2.50)
Question 2 positive
28 / 148 (18.9%)
40 / 502 (8.0%)
< 0.001
2.70 (1.60 – 4.55)
Question 3 positive
12 / 148 (8.1%)
20 / 502 (4.0%)
0.042
2.13 (1.01 – 4.46)
Question 4 positive
29 / 148 (19.6%)
27 / 502 (5.4%)
< 0.001
4.29 (2.45 – 7.52)
Question 5 positive
40 / 148 (27.0%)
66 / 502 (13.1%)
< 0.001
2.45 (1.57 – 3.82)
Question 6 positive
16 / 148 (10.8%)
29 / 502 (5.8%)
0.034
1.98 (1.04 – 3.75)
Dry eye
66 / 148 (44.6%)
132 / 502 (26.3%)
< 0.001
2.26 (1.54 – 3.30)
Schirmer I test ≤ 5 mm
37 / 147 (25.2%)
138 / 495 (27.9%)
0.517
0.87 (0.57 – 1.33)
BUT ≤10 seconds
22 / 26 (84.6%)
97 / 113 (85.8%)
0.872
0.91 (0.28 – 2.98)
Fluorescein score ≥ 1
9 / 26 (34.6%)
41 / 113 (36.3%)
0.873
0.93 (0.38 - 2.27)
Meibonian gland disease
13 / 26 (50.0%)
54 / 113 (47.8%)
0.839
0.92 (0.39 – 2.15)
* Major depression was defined as SGDS-K ≥ 8
Correlation between dry eye
symptom and depression
SGDS-K‡
No. of positive
responses to DEQ
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Patients with major depression
No. of Patients
Score
(Mean ± SD)
P value
No. (%)
0
427
3.62 ± 3.65
74 (17.3%)
1
103
5.24 ± 4.57
29 (28.2%)
2
61
5.15 ± 4.33
18 (29.5%)
3
38
6.34 ± 4.78
16 (42.1%)
4
15
6.53 ± 4.63
5
5
7.00 ± 4.53
3 (60.0% )
6
1
10.00
1 (100%)
Total
650
4.28 ± 4.08
148 (22.8%)
<0.001*
7 (46.7%)
P value
<0.001†
* One-way ANOVA, Post hoc test could not be performed because one group (positive
response =6) has fewer than two cases.
†Chi-square test (linear-by-linear association)
Conclusion

There is close relationship between dry eye symptoms
and depression, while no significant association was found
between depression and dry eye signs.

The present study suggests that
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There may be overlapped pathophysiology between major
depression and dry eye.
Dry eye may be in part a somatization disorder.
Further studies are required to elucidate the causes
leading to major depression and dry eye, and the exact
mechanisms that associate the two conditions.