Study On Impact Of Dry Eye Disease On Quality Of Life In Australians

Aims and Objectives

This paper proposes a study that would explore the impact of Dry Eye Disease (DED) on the Quality Of Life (QOL) in Australian patients. DED is a commonly diagnosed ocular disease that causes major disruptions in the lives of people. The study explores the literature to identify the studies already conducted on the subject and identified the gaps that are still there and can be filled by the current research. It proposes the research methods to be used for data collection and analysis.

The aim of this research is to study the impact of Dry Eye Disease (DED) on the Quality Of Life (QOL) in Australians. To achieve this aim, following research questions have to be answered:

• How is quality of life affected by DED?
• What are the symptoms and impacts of DED on patients?
• How does DED symptoms affect the life of people?

The research questions above can be converted into objectives of the research for exploration as follows:

• Identify the Vision related quality Of Life measures that are affected by DED
• Explore the symptoms of different types of DED and their impacts on QOL measures
• Understand the impact of DED diseases and symptoms on the quality of life of patients

Dry Eye Disease (DED) is one of the most common ocular-surface disorders that is faced by around 5% of children and 33% of the adult population. The disease affects the Quality Of Life (QOL) by causing vision impairments and other symptoms such as stinging, dryness, and fatigue (Schlarmann, Sabine, & Schnepp, 2018). These symptoms have a direct impact on the social and economic lives of those affected for a long duration. Typical difficulties faced in the disease include photophobia, unstable tear film, and visual disturbances (Tounaka, et al., 2014). DED is defined as multifactorial disease that affects the ocular surface and tear glands of the patients causing problems like increased tear osmolarity, blurred vision, ocular discomfort and inflammation. The disease is mostly caused due to tear deficiency caused by excessive evaporation of tears that damages the ocular surface and produces symptoms like irritation, dryness, itching, grittiness, soreness, stinging, pain, strain, blurriness of vision, foreign body sensation, burning, visual disturbance, and photophobia.  

Dry eye is one of the major symptoms of DED which can be caused or escalated by the presence of common chronic diseases like diabetes, arthritis, thyroid, and lupus. Medications given to patients for cure of such diseases as well as other health problems such as beta blockers, contraceptive’s, and antidepressants can also cause the dryness of eye. DED can be of two types that include Aqueous tear deficient and evaporative. Tear deficient DED can be Sjogren Syndrome or non-Sjogren syndrome. Evaporative DED is mostly caused by meibomian gland dysfunction (MGD). Several studies have already been conducted on DED that have revealed some insights on the cause, symptoms and impacts which can be useful to explore here. A study was conducted to rest the prevalence of dry eye disease in Southern Nigeria involving 730 patients. It was found that age and gender had association with the prevalence of the disease and that females were found to be more susceptible to DED with growing age than men (Onua & Chukwuka, 2017). A cross-sectional study conducted on 301 patients with DED was conducted to explore sleeping and mood disorders found in patients affected by eye diseases like DED. The study found that people with severe DED conditions were having problems with bed time and duration of sleep (Ayaki, et al., 2016).

Literature Review

To descriptively measure the impact of DED on QOL of patients, a quantitative survey will be implemented. A primary quantitative research would be done using a survey which would be conducted on 100 DED patients from Australia. Various methods that would be involved in the research are presented hereafter along with the justifications of sample size selection, data collection, and analysis.[My comment – This part should really describe the reasoning behind why you chose a survey.

For example: you wish to conduct a descriptive quantitative study to describe or measure a factor. In order to collect descriptive quantitative data, you have chosen a survey with discrete/multiple choice questions.]

SURVEY CHOICE IN DETAIL IN METHODS SECTION

This study would involve a quantitative survey which would be conducted through voluntary participation from patients of eye clinics in Australia. The survey has been selected as the primary method of data collected as it would give the researcher an opportunity to collected specific quantifiable data from multiple respondents in less time as the questionnaire would have objectives questions that could be answered faster.  [My comment – This part should really describe the reasoning behind why you chose a survey.

I EXPLAINED IT ALREADY]

Also, the data obtained from the survey would help researcher test the same using statistical methods that are scientific in nature and thus, would have more accuracy in results. Another reason survey would be an appropriate method of data collection is that it is cost effective when the sample size is large as a single questionnaire can be used for data collection and the administration of the same is also simpler.  Survey provides an opportunity to the researcher in taking views of a large number of people and provides flexibility of taking responses by various methods such as phone calls, online data collection, or face to face interviews. [My comment – My given solution did not have the para – A survey has been selected as the primary method of data collection as it allows the researcher to collect specific quantifiable data from multiple respondents in the shortest time frame. Also, the data obtained from the survey would help the researcher test the same using statistical methods that are scientific in nature and thus, meaning the results would be more accurate.]

A quantitative survey questionnaire would have nearly 20 questions and it would be conducted from  1st Nov 2018 to 30th Nov 2018. It would use a combination of different types of questions including closed-ended discrete and multiple-choice as well as the Likert scale questions. The question types would ensure the validity of the data to the objective the research which is to explore the impact of DED on QOL. [I HAVE EXPLAINED EVERY SECTION OF THE QUESTIONNAIRE IN DETAIL]

Questionnaire:

The questionnaire uses measures validated from previous studied conducted on DED. The respondents would be invited to fill in this questionnaire prepared to explore the following information: [Is there a validated questionnaire that measures this and rates severity? If there is you should use it and cite it here

Methodology

YOU DELETED DETAILS]

Demographics: the questionnaire would record the demographic information of patients including age, gender, occupation, and income. Gender and occupation would be measured on the nominal scale while age and income would make use of the ordinal scale with differential values distributed as ranges.

Lifestyle: Physical activity, smoking behaviour, and alcohol consumption of the patients would be measured to understand if there is a differential impact of patients of DED to their QOL among people living different lifestyles. The patterns of activities, behaviour and consumptions in respondents would be recorded using an ordinal scale defining their level of engagement in each of the case.

Symptoms of DED: The symptoms experienced and the quality of life measures. Symptoms that would be studied include fatigue, irritation, dryness, itching, grittiness, soreness, stinging, pain, strain, blurriness of vision, foreign body sensation, burning, visual disturbance, photophobia and issues in physical functioning. The symptoms experienced by the patients would be recorded using nominal variables and the Likert scale that would measure the presence of each symptom on a five differential scale identifying the level of severity.

Presence of other diseases: There are possibilities of confounding variables affecting the findings on the impact of DED on QOL in presence of specific diseases that patients may have.  Thus, tThe questions would also record the presence of other diseases that could cause similar symptoms to ensure if the impacts are only due to DED or could be a contribution from other diseases like hypertension, thyroid, cancer cardiovascular, diabetes, and dyslipidaemia. The presence of other disease would be marked by a nominal scale on which their presence would be marked or unmarked in the data.[ Wouldn’t you screen out people that had conditions which could confound your results?

THIS WAS EXPLAINED BUT DELETED IN YOUR FILE]

QOL: Questionnaire would note the Health-related quality of life (HRQOL) indicator to capture data on mental and physical health of these patients and would measure their current health status through the use of measures like general health status, physical unhealthy, mental unhealthy, and activity limitations (Yin, Njai, Barker, Siegel, & Liao, 2016).

This data would make use of the defined scale of HRQOL measuring the impacts only on the health-related QOS but as the results do not include lifestyle impacts other than the health condition of the body, the researcher would also make use of other QOL measures that would be separately recorded on the Likert scale defining the level of severity on a five-differential scale for them. QOL measures would include measures such as cost of medication, healthcare plan costs, productivity loss, daily activities performance impairments, loss of work days, and work performance loss (MCDONALD, PATEL, KEITH, & SNEDECOR, 2015).

The questionnaire would be developed using objective questions with nominal and ordinal scale variables and Likert scale along with the HRQOL scale.

Data Collection

To collect the data, the researcher would visit the clinics and take inputs from selected patients informing them about the purpose of the survey. The researcher would be asking questions to the patients and would be manually taking their responses on paper. The manual consent would be taken from the respondents who would be signing that they have been given the information about the purpose of survey and they are agreeing to provide information as well as give permission to use the same for the purpose of the current study.  If some patients are not available during the face to face survey, the researcher would take their contact number and would either interview them over calls or would fix up an appointment for the later date for the survey [HAS BEEN EXPLAINED BUT IT IS DELETED IN YOUR FILE].  In the case of the refusal from a selected patient to provide information, the researcher would revisit the list of patients provided by the doctor and would make selection of another patient to complete the data needed for the survey (Tounaka, et al., 2014).

Methods

Participants would be selected from the patients coming to eye clinics in Australia on the voluntary basis from the patients affected by any type of DED. The participants chosen would from the young adult and adult groups with age more than 19 [do they need to be over 18? MENTIONED VERY CLEARLY]. The respondents would be selected on the basis of certain parameters that include presence of DED, absence of any major disease other than DED, and major impacts on the life of individuals from DED. The researcher would thus personally select those respondents above the age of 19 with DED as a major health problem (Gideon, 2012).

This research would use purposive sampling as people with specific characteristics are required to be participating in the survey. The researcher would visit 10 eye clinics from where 100 patients would be selected and the research would try to create a balance between gender and age groups to make the sample most representative of the affected population.  A sample size of minimum 100 is recommended for any population above 5000 to get the definite patterns that can be generalizable [The sentence “<<detail test to show that you can reach 95% confidence by sampling 100 people>>.” Which is asked to delete was never there in my solution]. The sample size has been determined on the basis of the perspective of the research on the sufficiency of data that could make a good representative of the population. Also considering the time, budget, and logistics complications needing permissions from doctors as well as patients has been a determining factor for the selection of the sample size.

The data collected would be coded into SPSS and the statistical analysis would be performed to identify the DED factors and symptoms that are causing impacts on the quality of life parameters. For this correlation and regressions tests would be run between the symptoms experienced by the patients and the quality of life measures as well as between the type of DED and the quality of life measures. The analysis would also identify if there could be other contributing factors to QOL problems such as other diseases and life style issues. Based on the analysis, a model can be prepared which identifies different types of DEDs with associated symptoms and the type of quality of life impairments that are caused due to them (Kaplan & Fryback, 2010).

The research would make use of following data analysis methods:

Descriptive Analysis: Descriptive analysis would be used on the variables reflecting demographics and symptoms to understand the distribution of participants in the survey with respect to demographics and other factors including gender and age. he results of this analysis would be presented using tables and graphical representations.

Correlation: Correlation tests would be run between the factors identifying presence of DED and its symptoms and the factors representation the QOS. The symptoms that would be tested in the correlation test would include irritation, dryness, itching, grittiness, soreness, stinging, pain, strain, blurriness of vision, foreign body sensation, burning, visual disturbance, and photophobia. The QOS factors that would be correlated with each of these symptoms would include HRQOL measures, medication, healthcare plan costs, productivity loss, daily activities performance impairments, loss of work days, and work performance loss.

Regression: If a significant correlation is found between the factors representing symptoms of DED and the factors representing QOL measures then a regression test would be run on those factors to test if there exists a causal relationship between them so that the factors that actually caused the QOL disruptions can be identified (Engel, Jann, Lynn, Scherpenzeel, & Sturgis, 2014).

Based on the findings of the regression, a clinical model would be proposed which would explain how DED patients feel the symptoms and how these symptoms lead to disruptions in their quality of life [do you need a reference list or will this be at the end of the chapter? REFERENCES ARE ALREADY BEEB PROVIDED].

As the research involved a primary survey in which respondents are taken the sensitive information from, the researcher needs to take care of the ethical codes of conduct like confidentiality, privacy, and informed consent. For this, the researcher would take a written permission from all those participating in the survey and would keep them informed of the objective of the survey with a promise to not use the information for any other purpose. The collected data would be deleted once its analysis and presentation are completed. The researcher would not take any personally identifiable information from the selected patients like personal identification number, email ID or contact number to ensure that privacy is maintained (Yanagawa, Takai, Yoshimaru, & Kida, 2014).

Besides these, the researcher also needs to take care of the research related codes of conduct for ethical representation for which the researcher would need to ensure that the survey is not biased by his own opinions and thus, after creation of the questionnaire it would be tested by taking peer reviews before it is finalized. The researcher would also make sure that the data collected would not be manipulated in any way and would be used objectively to present the findings as it is. In case of any data missing, the researcher would take the confirmation from then patient selected and would not fill the gaps just to complete the data for analysis (Shigeyasu, et al., 2018).

The project would take three months to complete which would include study of literature, preparation of questionnaire, data collection, data analysis and report generation. The timelines for individual research activities have been given in the Gantt chart below:

Research Task/weeks	1	2	3	4	5	6	7	8	9	10	11	12
Aims & Objectives
Literature review
Questionnaire design and approval
Data Collection
Data analysis
Report preparation
Proofreading and editing

Stakeholders of a research project are the people who affect or are affected by the project in any way. The researcher has identified some major stakeholders of the research project who would be involved in the project in the defined ways:

• DED patients who are participating in the survey would be answering the survey questions for the purpose of this study and their responses would be analysed to draw findings and conclusions
• Guide or tutor would be involved in providing guidance on how to proceed with the research through feedbacks and the researcher would be updating him on research progress actively
• Doctors working in the clinics from where patients are selected would be involved in the research process as they would be providing the data on their patients to help the researcher identify the patients to select for the survey(Siedlecki, Butler, & Burchill, 2010).
• Other students would be helping the researcher test the questionnaire to identify any biases and suggest improvements before the questionnaire could be finalized and sent for approval
• Healthcare community would be helped by this research as they would be shared the findings with as it can help them take steps to improve conditions of the people and patients affected by DED

The research would be communicated to the desired audience that include the patients, academic, health communities and organizations. The organizations and communities would be communicated through publishing of the article in related journals summarizing the findings from the research. Patients participating in the survey would be communicated through email by sending them the copies of synopsis highlighting the major research findings (NIDRR, 2001). The researcher would also submit the full research report to the university for disseminating its findings for academic advances. The journal publications would increase the reach to the aider community of academicians in the field of healthcare. The researcher would present the findings in national and international journals to reach out to them (Wilson, Petticrew, Mike W Calnan, & Nazareth, 2010).

The proposed research would explore the impacts of DED on the QOL of patients in Australia. The disease is very common in adults and is found in over 33% of them across globe. The cause of DED could be many including other diseases and the symptoms generated able affecting the lives of people in severe ways. With the understanding of the factors that cause the major disruptions in the lives of patients can help the healthcare community evaluate the real impact of DED and prescribe solutions for improvement of the lives of people who are affected. The research findings would add value to the research community by delivering new insights that would add to the body of knowledge on DED. The research would help the researcher gain an understanding of what symptoms of DED causes disruptions in QOL of people living in Australia and identify specific factors and symptoms that are either causing or escalating the impacts on patients. With the help of the findings obtained from this research, the causes of lifestyle disruptions could be understood and based on the same, prescriptive measures could be suggested to the patients to help them alleviate their conditions and improve their lives.

Conclusions

The paper proposes a research to be conducted on the 100 DED patients from Australian clinics to understand the impacts of DED on QOL of the patients. It proposing conducting a survey on the selected patients in order to identify the cause, symptoms, demographics, lifestyle, and quality of life measures so that the identified factors can be evaluated for their impacts caused on the QOL of people. Based on this analysis, a model can be proposed for explaining the impacts of DED on the life of people through identification of the impacting factors and the quality of life measures.

References

Ayaki, M., Kawashima, M., Negishi, K., Kishimoto, T., Mimura, M., & Tsubota, K. (2016). Sleep and mood disorders in dry eye disease and allied irritating ocular diseases. Scientific Reports, 22480, 1-7.

Engel, U., Jann, B., Lynn, P., Scherpenzeel, A., & Sturgis, P. (2014). Improving Survey Methods: Lessons from Recent Research. Routledge.

Gideon, L. (2012). Handbook of Survey Methodology for the Social Sciences. Springer.

Kaplan, R. M., & Fryback, D. G. (2010). Health Related Quality of Life and Health Status. National Institutes of Health.

MCDONALD, M., PATEL, D. A., KEITH, M. S., & SNEDECOR, S. J. (2015). Economic and Humanistic Burden of Dry Eye Disease in Europe, North America, and Asia: A Systematic Literature Review. Clinical Science, 14(2), 144-167.

NIDRR. (2001). Beyond Scientific Publication: Strategies for Disseminating Research Findings. Yale Center for Interdisciplinary Research .

Onua, A. A., & Chukwuka, I. O. (2017). Prevalence of Dry Eye Disease in a Rural Niger Delta Community, Southern Nigeria. Ojoph, 7(2), 95-102.

Schlarmann, J. g., S. M.-B., & Schnepp, W. (2018). The use of health-related quality of life (HRQOL) in children and adolescents as an outcome criterion to evaluate family oriented support for young carers in Germany: an integrative review of the literature. BMC Public Health, 8(414), 10-34.

Shigeyasu, C., Yamada, M., Kawashima, M., Suwaki, K., Uchino, M., Hiratsuka, Y., . . . Tsubota, K. (2018). Quality of life measures and health utility values among dry eye subgroups. Health and Quality of Life Outcomes, 16(170), 1-12.

Tounaka, K., Yuki, K., Kouyama, K., Abe, T., Tsubota, K., Kawabe, H., & Yokoyama, K. (2014). Dry Eye Disease Is Associated with Deterioration of Mental Health in Male Japanese University Staff. The Tohoku Journal of Experimental Medicine, 3, 215-200.

Wilson, P. M., Petticrew, M., Mike W Calnan, & Nazareth, I. (2010). Disseminating research findings: what should researchers do? A systematic scoping review of conceptual frameworks. Implement Sci., 5(91), 1-12.

Siedlecki, S. L., Butler, R. S., & Burchill, C. N. (2010). Survey Design Research: A Tool for Answering Nursing Research Questions. Clinical Nurse Specialist, 29(4), E1-E8.

Yanagawa, H., Takai, S., Yoshimaru, M., & Kida, K. (2014). Nurse awareness of clinical research: A survey in a Japanese University Hospital. BMC Medical Research Methodology, 14(1), 85.

 Yin, S., Njai, R., Barker, L., Siegel, P. Z., & Liao, Y. (2016). Summarizing health-related quality of life (HRQOL): development and testing of a one-factor model. Popul Health Metr., 14(22), 105.