Dry Eye Diagnosis Is an Independent Risk Factor for Developing Depression and Anxiety Among Elderly

Purpose: To evaluate whether dry eye disease (DED) diagnosis may increase the subsequent risk of developing depression and anxiety. Methods: In this retrospective cohort study, Medicare beneficiaries aged 65 and older with a new diagnosis of DED, no prior history of depression and/or anxiety disorder, and continuous follow-up between 2011 and 2015 were identified from a 5% random sample of nationwide Medicare claims. Beneficiaries included in the DED cohort were matched to a non-DED cohort at a 1:4 ratio using propensity scores based on demographic factors and systemic comorbidities. Crude incidence rates and rate ratios for depression and anxiety were calculated. Multivariable Cox proportional hazards regression model was fit to evaluate the impact of demographic factors and dry eye on the risk of developing these conditions while adjusting for systemic comorbidities. Main Outcome Measures: Longitudinal incidence of depression and anxiety in DED versus non-DED groups. Results: The unadjusted incidence of depression was 30% higher [incidence rate ratio 1.30, 95% confidence interval (CI), 1.24‒1.36] in the DED cohort, and the unadjusted incidence of anxiety was 50% higher (incidence rate ratio 1.50, 95% CI, 1.41–1.58) compared with the non-DED group. The increased susceptibility to depression (adjusted hazard ratio 1.25, 95% CI, 1.19–1.31) and anxiety (adjusted hazard ratio 1.45, 95% CI, 1.37–1.54) because of DED remained significant after adjusting for demographic factors and systemic comorbidities. Conclusions: DED is an independent risk factor for developing depression and anxiety in the elderly.