Findings from a recent systematic review published in the American Journal of Ophthalmology summarized current associations between social determinants of health (SDOH) indicators and dry eye in the United States.
Give me some background.
SDOH are the non-medical factors that influence health outcomes; the five overarching SDOH domains are as follows:
- Neighborhood and built environment
- Economic stability
- Social and community context
- Education access and quality
- Healthcare access and quality
While the prevalence of dry eye is approximately 8% in the United States, the actual disease burden is likely much higher.
- Why: Due to the discrepancy in clinical signs and symptoms—particularly between symptomatic and asymptomatic dry eye.
Tie it together for me.
Early detection and treatment of dry eye can help to prevent further or future ocular surface damage, but this likely depends on a patient’s access to regular eye examinations and the ability to afford healthcare.
Consequently: The study authors sought to identify disparities in the disease burden of dry eye (through the lens of SDOH) to suggest future directions of research.
Talk about the study.
In November 2022, investigators performed a comprehensive literature search on Ovid MEDLINE, Embase, and Web of Science.
They included studies identified as potential “indicators” of SDOH when the factors they analyzed could be mapped to at least one of the five SDOH domains.
Note: In the context of SDOH, an “indicator” refers to a specific measurement or observable data point that serves as evidence of a sign of a particular social and economic phenomenon (e.g., income level, educational attainment, air quality, etc.).
Findings?
In total, the study included 18 studies that reported on 51 potential SDOH indicators, which were mostly focused on how climate and air quality affect dry eye (i.e., the neighborhood and built environment SDOH domain).
None of the 18 studies identified SDOH measures that were associated with improvements in dry eye—and of these studies, 13 were judged as having a high risk of bias.
Tell me more about the included studies.
The investigators reported the associations (including adjusted and unadjusted) between dry eye measures and SDOH indicators:
- Dry eye diagnosis and care
- 15 of 19 associations (79%) revealed an increase in the diagnosis of dry eye or delayed specialty care for it
- Dry eye symptoms
- 34 of 56 associations (61%) demonstrated exacerbated dry eye symptoms
- Corneal fluorescein staining (CFS)
- 15 of 23 (65%) showed no association with CFS
- Tear break-up time (TBUT)
- 10 of 22 associations (45%) unveiled an increased TBUT, while another 10 (45%) showed no association
Expert opinion?
The study authors noted that the review highlighted the limited body of evidence on the connection between dry eye treatment outcomes, healthcare access, educational access, and economic stability.
“This dearth of primary data investigating the upstream factors impacting individuals’ access to dry eye care parallels the issue of dry eye being underdiagnosed,” they added.
For example: Only one of the 18 included studies investigated the link between participants’ level of education and dry eye diagnosis, revealing that those with higher educational degrees were more aware of their dry eye condition.
Limitations?
Some of the limitations in this systematic review were the heterogeneity in association, study design, and varying measurement definitions, such as reviewing medical records vs. self-reported data.
Tie it all together for me.
These findings revealed a consistent association between SDOH indicators and unfavorable dry eye outcomes in the U.S., such as:
- Higher disease burden
- Worse symptoms
- Delayed referral
This study also revealed the scarcity of evidence on healthcare access, educational access, and economic stability in relation to dry eye—highlighting the need for further research in these SDOH domains as well as other aspects of obtaining quality eye care beyond accessibility.