Purpose (1) To determine the independent association of dry eye symptoms with health-related quality of life (HRQoL) in the Singapore population and (2) to further investigate which factors mediate this association. Methods In this cross-sectional study, 7707 participants were included. The presence of dry eye symptoms was defined as experiencing at least one out of the six symptoms either ‘often’ or ‘all the time’. The EuroQoL-5 dimensions (EQ-5D) utility instrument (raw scores converted to UK time trade-off (TTO) values) was used to assess generic HRQoL and the overall score from the Visual Functioning Questionnaire for visual functioning. The association between dry eye symptoms and EQ-5D was investigated using multivariable linear regression, adjusting for demographic and socioeconomic information, comorbidities, systemic and ocular examinations results. Mediation analysis was used to determine whether certain factors mediated this association. Results After adjusting for relevant factors, those with dry eye symptoms had significantly lower HRQoL (difference in EQ-5D TTO: −0.062 (95% CI −0.073 to –0.050)), with the inability to open eyes affected the most (−0.101 (95% CI −0.161 to –0.042)), followed by a sandy sensation (−0.089 (95% CI −0.121 to –0.058)), a burning sensation (−0.070 (95% CI −0.105 to –0.036)), red eyes (−0.059 (95% CI −0.082 to –0.036)), a dry sensation (−0.058 (95% CI −0.072 to –0.044)) and crusting of eyelids (−0.040 (95% CI −0.071 to –0.008)). Visual functioning and the presence of recent falls accounted for 8.63% (4.98%–14.5%) and 2.93% (0.04%–5.68%) of the indirect relationship between dry eye and HRQoL, respectively. Conclusion Dry eye symptoms were independently associated with poor HRQoL. Moreover, this was partly mediated by reduced visual functioning and experiencing recent falls. Our results suggest that efforts to reduce severity of dry eye symptoms are essential to optimise patients’ overall functioning and well-being. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to this paper are tabulated in tables (either in the main paper or in supplemental tables).

中文翻译：

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干眼症状与生活质量之间的关系：关联和中介分析

目的 (1) 确定新加坡人群干眼症状与健康相关生活质量 (HRQoL) 的独立关联，以及 (2) 进一步调查哪些因素介导了这种关联。方法 在这项横断面研究中，纳入了 7707 名参与者。干眼症状的存在被定义为“经常”或“一直”经历六种症状中的至少一种。EuroQoL-5 维度 (EQ-5D) 实用工具（原始分数转换为英国时间权衡 (TTO) 值）用于评估一般 HRQoL 和视觉功能问卷的视觉功能总体分数。使用多变量线性回归研究干眼症状与 EQ-5D 之间的关联，并根据人口和社会经济信息、合并症、全身和眼部检查结果进行调整。中介分析用于确定某些因素是否介导了这种关联。结果 调整相关因素后，有干眼症状的患者HRQoL显着降低（EQ-5D TTO差异：-0.062（95% CI -0.073至–0.050）），其中无法睁眼影响最大（-0.101） （95% CI -0.161 至 –0.042）），然后是沙感（-0.089（95% CI -0.121 至 –0.058））、烧灼感（-0.070（95% CI -0.105 至 –0.036）），红眼（-0.059（95% CI -0.082 至 –0.036））、干燥感（-0.058（95% CI -0.072 至 –0.044））和眼睑结痂（-0.040（95% CI -0.071 至 –0.008） ））。视觉功能和最近跌倒的情况分别占干眼与 HRQoL 之间间接关系的 8.63% (4.98%–14.5%) 和 2.93% (0.04%–5.68%)。结论 干眼症状与较差的 HRQoL 独立相关。此外，这在一定程度上是由于视觉功能下降和最近跌倒造成的。我们的结果表明，努力减轻干眼症状的严重程度对于优化患者的整体功能和福祉至关重要。与研究相关的所有数据都包含在文章中或作为补充信息上传。与本文相关的所有数据均以表格形式列出（在主论文或补充表格中）。