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Dry eye makes reading a struggle
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Patients with dry eye who regularly participate in sustained, silent reading experience a statistically significant drop in reading performance, according to a study published in Optometry and Vision Science.
Co-author, Esen K. Akpek, MD, corresponded with Primary Care Optometry News regarding the results of this study.
“[These] patients normally have 20/20 visual acuity when measured in the clinic. However, they bitterly complain that they can’t read,” Akpek told PCON. “Now we understand that they don’t mean they can’t see to read. What they mean [is] they cannot sit and read for prolonged periods of times (even 30 minutes). Their reading speed slows down, they get visual fatigue and cannot sustain the reading.”
Akpek and colleagues recruited 116 dry eye patients, 39 presenting only dry eye symptoms and 31 controls, all 50 years old or older. After the ocular surface disease index questionnaire, objective testing tear film stability studies, Schirmer's test and ocular surface staining was performed, researchers calculated the scores for the Ocular Surface Disease Index, vision and discomfort.
According to the study, reading speed for each group was calculated as words per minute and compared across the three groups. To measure each of the three groups’ reading abilities a short-duration out-loud reading as well as a 30-minute sustained silent reading test was performed.
“Similarly, prior research on reading speeds in patients with glaucoma found stronger associations between visual measures and reading speed using sustained silent reading test as opposed to short-duration out-loud reading,” the authors wrote. “It is conceivable that prolonged reading pushes individuals to perform closer to their maximum capacity/strain and is, therefore, more impacted by findings (ie, corneal staining in dry eye patients or visual field loss in glaucoma patients), which might affect the recognition and processing of words.”
Patients from the clinically significant dry eye group had a statistically significant slower sustained silent reading speed compared with controls. While words per minute (wpm) dropped from 272 wpm to 240 wpm, their out-loud reading speed was now shown to be significantly slower, dropping from 153 wpm to 146 wpm.
Researchers reported that patients in the dry eye symptoms only group did not show a statistically significant loss in reading speed in either out-loud or sustained silent reading tests when compared to the control group.
“Previous studies demonstrated that patients with dry eye frequently report inability to work or perform activities of daily living and get poor scores on vision-related quality-of-life measures,” the authors wrote. “Reading is necessary for many activities of daily living, both leisure and work related. The difficulty with reading may affect employment or decrease workplace productivity, particularly in individuals who work at an office setting.” – by Scott Buzby
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Scott Schachter, OD
As we see increasing prevalence of dry eye disease amongst all age groups, likely due to device use, it’s more important than ever to screen for it in our practices. This recent study takes a look at the effect of dry eye on prolonged silent reading speed. Subjects were age 50 years and older.
The authors found that patients with dry eye symptoms, sans signs, performed the same as the normal control group. When corneal staining was present, however, reading speed decreased significantly.
In addition to affecting quality of life, slower reading speed can result in presenteeism, or decreased work performance.
The clinical takeaway? While it is important to screen for dry eye symptoms with a validated questionnaire, this study also highlights the need to look for and resolve corneal staining on these patients.
Also, ask your patients if they are having any trouble reading. If so, take a careful look at the cornea.
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