Preliminary report of improved sleep quality in patients with dry eye disease after initiation of topical therapy
Received 18 August 2015
Accepted for publication 4 December 2015
Published 16 February 2016 Volume 2016:12 Pages 329—337
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Xiang Mou
Peer reviewer comments 2
Editor who approved publication: Professor Wai Kwong Tang
Masahiko Ayaki,1 Ikuko Toda,2 Naoko Tachi,3 Kazuno Negishi,1 Kazuo Tsubota1
1Department of Ophthalmology, Keio University School of Medicine, 2Department of Ophthalmology, Mimamiaoyama Eye Clinic, Tokyo, 3Eye Center, Shinseikai Toyama Hospital, Imizu, Japan
Purpose: Dry eye disease (DED) is potentially associated with sleep and mood disorders. This study evaluated sleep quality in patients with DED using a questionnaire-based survey before and after topical eyedrop treatment. The effectiveness of sleep and ophthalmic services in assisting with sleep problems in patients with eye disease was also assessed.
Methods: Seventy-one consecutive patients with DED visiting eight general eye clinics in various locations answered a questionnaire containing the Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale. Photophobia and chronotype (morningness/eveningness) were also evaluated with two representative questions from established questionnaires (National Eye Institute Visual Function Questionnaire-25 and Morningness/Eveningness questionnaire). Follow-up evaluation was conducted by interview or mail 3–10 months after the initial evaluation. A sleep service was established in two eye clinics to identify possible ocular diseases related to sleep and mood disorders; it comprised a questionnaire, sleep diary, actigram, medical interviews, visual field testing, retinal ganglion cell layer thickness measurement, and DED examination.
Results: Patients with newly diagnosed DED exhibited a greater improvement in sleep after DED treatment compared with patients with established DED. Improvement in Pittsburgh Sleep Quality Index was significant (P<0.05) and strongly correlated with improvement in Hospital Anxiety and Depression Scale (P<0.05) for new patients, but not for patients with established DED. Ten eye clinic patients visited the sleep service and nine of them had DED. They were successfully treated with eyedrops and sleep services, which included blue-light-shield eyewear and wearable blue-light therapy lamps according to their problem.
Conclusion: Sleep quality improved in patients with DED after topical treatment with or without the sleep service. Psychiatric treatment focusing on sleep disorders could be beneficial for patients with DED.
Keywords: sleep, dry eye, liaison psychiatry, depression, anxiety
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