Associations of the Severity of Dry Eye Symptoms and Signs with Quality of Life in the Dry Eye Assessment and Management (DREAM) Study

<b>Purpose:</b> To assess associations of the severity of the symptoms and signs of dry eye disease (DED) with the quality of life in patients with moderate-to-severe DED. <b>Methods:</b> At baseline, 6 and 12 months, participants (n = 535) were assessed for DED symptoms using the Ocular Surface Disease Index (OSDI) and signs using conjunctival staining, corneal staining, tear break-up time (TBUT), Schirmer's testing, meibomian gland dysfunction, and tear osmolarity. Quality of life was evaluated using the Short Form Health Survey (SF-36), consisting of a Physical Component Summary (PCS) and Mental Component Summary (MCS). Spearman correlation coefficients (rho) were used to evaluate correlations between the severity of DED and the SF-36. <b>Results:</b> At baseline, worse DED symptoms indicated by a higher OSDI total score were correlated with worse PCS (rho = -0.13, <i>p</i> = 0.002) and MCS (rho = -0.09, <i>p</i> = 0.03) in the SF-36. Worse vision-related function was correlated with a worse PCS score (rho = -0.18, <i>p</i> < 0.0001), and worse ocular symptoms were correlated with a worse MCS score (rho = -0.15, <i>p</i> < 0.001). More severe DED signs including corneal staining (rho = -0.22, <i>p</i> < 0.001), Schirmer test (rho = 0.11, <i>p</i> = 0.01), TBUT (rho = 0.14, <i>p</i> < 0.001), and tear osmolarity (rho = -0.12, <i>p</i> = 0.02) were correlated with a worse PCS score but were not correlated with MCS score (<i>p</i> ≥ 0.39). ln longitudinal analysis, only the worsening of ocular symptoms was significantly correlated with the worsening of the MCS score (rho = -0.09, <i>p</i> = 0.04). <b>Conclusions:</b> In patients with moderate-to-severe DED, there were significant yet weak correlations between the severity of dry eye symptoms/signs and the physical or mental components of the SF-36. Healthcare professionals should offer patients with DED symptom relief and support for the emotional and practical challenges in their daily lives.