Association between dry eye and depressive symptoms: Large-scale crowdsourced research using the DryEyeRhythm iPhone application

Takenori Inomata, Masao Iwagami, Masahiro Nakamura, Tina Shiang, Keiichi Fujimoto, Yuichi Okumura, Nanami Iwata, Kenta Fujio, Yoshimune Hiratsuka, Satoshi Hori, Kazuo Tsubota, Reza Dana, Akira Murakami

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)


Purpose: Dry eye (DE) disease and depression are increasing in modern times. We investigated the association between DE and depressive symptoms using the iPhone application, DryEyeRhythm. Methods: This large-scale crowdsourced observational study was conducted within iPhone users in Japan who downloaded DryEyeRhythm. Participants with a Zung Self-rating Depression Scale (SDS) score ≥ 40 were defined as having depressive symptoms, and those with an Ocular Surface Disease Index (OSDI) score ≥ 13 were defined as having DE symptoms (mild, 13–22; moderate, 23–32; and severe, 33–100). We compared SDS scores between participants with normal eye and mild, moderate, and severe OSDI-based DE symptoms. Logistic regression analyses were used to determine the association between DE severity and depressive symptoms after adjustment for demographic characteristics, medical history, and lifestyle habits. Results: This study included 4454 participants (mean age, 27.9 ± 12.6 years; female, 66.7%). Participants with SDS scores ≥40 accounted for 58.2%, 70.9%, 79.4%, and 85.0% of normal controls and participants with mild, moderate, and severe DE symptoms, respectively (P trend < 0.001). The adjusted odds ratios (95% confidence interval) for depressive symptoms (SDS score of ≥40) were 1.62 (1.35–1.95) for mild, 2.39 (1.92–2.97) for moderate, and 3.29 (2.70–4.00) for severe DE symptoms. Conclusion: This large-scale crowdsourced clinical study using DryEyeRhythm suggests that depressive symptoms are more common in individuals with more severe DE symptoms. DryEyeRhythm could play a role in earlier prevention or future prospective interventions for depressive symptoms in individuals with DE symptoms.

Original languageEnglish
Pages (from-to)312-319
Number of pages8
JournalOcular Surface
Issue number2
Publication statusPublished - 2020 Apr


  • Crowdsourced research
  • Depression
  • Dry eye disease
  • DryEyeRhythm
  • Researchkit

ASJC Scopus subject areas

  • Ophthalmology


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