American journal of ophthalmology · 2026
Risk of Incident Dry Eye Disease Among Patients With Chronic Pain Conditions.
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Fish Shannan, Shmushkevich Shon B, Zhang Charles, Felix Elizabeth R, Lott Lindsey B DE, Galor Anat
Аннотация
OBJECTIVE: To evaluate whether chronic pain conditions (CPCs) are associated with increased risk of incident dry eye disease (DED) and prescription-requiring DED in a large electronic health record network.
DESIGN: Retrospective cohort study.
SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Adults aged 18 years or older in the TriNetX Analytics Network (2005-2025) with a qualifying ophthalmology examination and no prior DED diagnosis. The exposure cohort included patients with at least one CPC diagnosis before the index visit; controls had no CPC diagnoses before or after the index visit. After 1:1 propensity score-matching, 538 364 patients were included per cohort. A validation cohort restricted to patients with age-related cataract included 506 763 matched patients per group.
METHODS: Patients were identified using ICD-10-CM, SNOMED, and CPT codes. Propensity score matching balanced demographics and comorbidities. Two outcomes were assessed at 1, 2, and 3 years after the index visit: incident DED, defined by a new diagnosis of dry eye syndrome or keratoconjunctivitis sicca not specified as Sjögren's, and prescription-requiring DED, defined by initiation of topical cyclosporine or lifitegrast. Risk ratios with 95% confidence intervals were calculated. Time-to-event analyses used Kaplan-Meier curves and multivariable Cox proportional hazards models.
MAIN OUTCOME MEASURES: Incident DED and prescription-requiring DED.
RESULTS: Patients with at least one CPC diagnosis had significantly higher risk of incident DED compared with controls at all follow-up intervals. At 1 year, incident DED occurred in 3.34% of the CPC cohort versus 0.72% (RR 4.64; 95% CI, 4.49-4.81; P < .0001). At 3 years, cumulative incidence increased to 7.16% versus 1.50% (RR 4.78; 95% CI, 4.66-4.89; P < .0001). Prescription-requiring DED was also more common in the CPC cohort at 3 years (0.79% vs 0.30%; RR 2.60; 95% CI, 2.45-2.75). In multivariable Cox regression, CPCs were independently associated with increased hazard of incident DED (hazard ratio 4.85; 95% CI, 4.76-4.94; P < .0001). Findings were consistent in the validation cohort.
CONCLUSIONS: CPCs are strongly associated with an increased risk of incident and prescription-requiring DED. These findings support consideration of CPCs as risk factors in the evaluation and management of DED and suggest that a subset of patients with DED may reflect broader pain-processing abnormalities.
DESIGN: Retrospective cohort study.
SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Adults aged 18 years or older in the TriNetX Analytics Network (2005-2025) with a qualifying ophthalmology examination and no prior DED diagnosis. The exposure cohort included patients with at least one CPC diagnosis before the index visit; controls had no CPC diagnoses before or after the index visit. After 1:1 propensity score-matching, 538 364 patients were included per cohort. A validation cohort restricted to patients with age-related cataract included 506 763 matched patients per group.
METHODS: Patients were identified using ICD-10-CM, SNOMED, and CPT codes. Propensity score matching balanced demographics and comorbidities. Two outcomes were assessed at 1, 2, and 3 years after the index visit: incident DED, defined by a new diagnosis of dry eye syndrome or keratoconjunctivitis sicca not specified as Sjögren's, and prescription-requiring DED, defined by initiation of topical cyclosporine or lifitegrast. Risk ratios with 95% confidence intervals were calculated. Time-to-event analyses used Kaplan-Meier curves and multivariable Cox proportional hazards models.
MAIN OUTCOME MEASURES: Incident DED and prescription-requiring DED.
RESULTS: Patients with at least one CPC diagnosis had significantly higher risk of incident DED compared with controls at all follow-up intervals. At 1 year, incident DED occurred in 3.34% of the CPC cohort versus 0.72% (RR 4.64; 95% CI, 4.49-4.81; P < .0001). At 3 years, cumulative incidence increased to 7.16% versus 1.50% (RR 4.78; 95% CI, 4.66-4.89; P < .0001). Prescription-requiring DED was also more common in the CPC cohort at 3 years (0.79% vs 0.30%; RR 2.60; 95% CI, 2.45-2.75). In multivariable Cox regression, CPCs were independently associated with increased hazard of incident DED (hazard ratio 4.85; 95% CI, 4.76-4.94; P < .0001). Findings were consistent in the validation cohort.
CONCLUSIONS: CPCs are strongly associated with an increased risk of incident and prescription-requiring DED. These findings support consideration of CPCs as risk factors in the evaluation and management of DED and suggest that a subset of patients with DED may reflect broader pain-processing abnormalities.