Dry eye and high myopia in teenagers

Paper title: Dry eye disease and high myopia in teenagers; a reciprocal relationship

Authors: Osama Ibrahim Hirayama (1), Mashahiko Ayaki (1,2), Erisa Yotsukura (1), Hidemasa Torii (1), Kazuno Negishi (1)

1. Department of Ophthalmology, Keio University School of Medicine, Japan
2. Otake Clinic Moon View Eye Center, Kanagawa, Japan

Date: June 2022

Reference: Hirayama OI, Ayaki M, Yotsukura E, Torii H, Negishi K. Dry eye disease and high myopia in teenagers; a reciprocal relationship. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1442 - F0400. [Link to abstract]

This abstract reported on the relationship between dry eye disease (DED) and high myopia (HM) in Japanese teenagers. In this retrospective case series, a dry eye-related questionnaire was used to compare subjective symptoms of dryness, irritation, fatigue, blurring and photophobia, between highly myopic (n=106), mildly myopic (n=494) and non-myopic (n=82) patients aged 10-19 years.

• The highly myopic group reported significantly more dryness, less pain and photophobia compared than the non-myopic group. Dryness was correlated with higher level of myopia, whereas photophobia and pain were correlated with lower level of myopia. 
• Most of the symptoms, except fatigue, were associated with refractive error. 
• In terms of objective results, myopia was associated with the presence of diagnosed dry eye disease and short tear break up time
• Astigmatism and anisometropia were greater among the patients with high myopia than the other groups.

Clinically, this means that objective dry eye disease and reduced tear break up time is associated with myopia. However, the objective symptoms reported by these young patients may be variable. Therefore, we need to be cognizant of actively screening for dry eye disease in this population. 

Read more about risk factors for dry eye and how to manage it in this Clinical Article covering Dry eye in myopia management.

The objective reports of symptoms of dry eye disease were variable in this group, with symptoms of dryness correlating with myopia, but not symptoms of pain or photophobia. Further investigation is required to uncover the mechanism behind this.

Title: Dry eye disease and high myopia in teenagers; a reciprocal relationship

Authors: Osama Ibrahim Hirayama, Mashahiko Ayaki, Erisa Yotsukura, Hidemasa Torii, Kazuno Negishi

Purpose:  To investigate the relation between dry eye disease (DED) and high myopia (HM) in Japanese teenagers.

Methods: The Institutional Review Board and Ethics Committee of Tsukuba Central Hospital and Kanagawa Medical Association approved this study. This study was a retrospective, descriptive, consecutive case series. We compared the dry eye condition in 106 HM patients (mean age, 16.4 ± 2.2y), 494 mild myopic (MM) patients (15.0 ± 2.6y), and 82 non-myopic (NM) subjects (13.8 ± 2.6y) aged between 10 and 19 years old at Japanese eye clinics. Myopia, astigmatic error, and anisometropia were assessed. Dry eye-related symptoms questionnaire including; dryness, irritation, pain, fatigue, blurring and photophobia were evaluated. Intraocular pressure, tear film break-up time (BUT) and fluorescein staining were investigated. The need for consent was waived by the Institutional Review Board. Regression analysis of myopic error and other variables was conducted.

Results: Anisometropia and astigmatic error were greatest in the HM group compared with other groups (P < 0.001). HM group reported more dryness (P = 0.034), less photophobia (P < 0.001), and less pain (P = 0.039) compared with NM group. Most of the symptoms except for fatigue were apparently associated with myopic error. Regression analysis revealed that astigmatic error (β = -0.231, P < 0.001), anisometropia (β = -0.191, P < 0.001), short BUT (β = -0.086, P = 0.028), and presence of diagnosed DED (β = -0.112, P = 0.003) were correlated with myopic error. Regarding symptoms, dryness (β = -0.127 P = 0.004), photophobia (β = 0.117, P = 0.002), and pain (β = 0.084, P = 0.034) were correlated with myopic error as well.

Conclusion: Our study showed significant clinical findings of DED in HM patients. The present results indicated DED might be associated with HM in teenagers.

[Link to abstract]