Darrell E. White, MD, is the founder of Skyvision Centers in Ohio. His blog for Ocular Surgery News will focus on issues related to dry eye disease.

BLOG: The rhythm method in dry eye care

Got your attention with that headline, didn’t I? Actually, there really is something called “DryEyeRhythm.” It’s not a new dance move but an iPhone app developed by a group of Japanese investigators to perform large-scale crowdsourced research on dry eye disease. It was initially released in Japan in November 2016 with a subsequent U.S. release date of April 2018. No results have been published from the U.S., but the data from Japan are very interesting.*

DryEyeRhythm was downloaded 18,225 times in Japan between Nov. 2, 2016, and Nov. 2, 2017. The app collected demographic and health information (filled out by 10,961 users), as well as a lifestyle survey and an OSDI (5,265 completed). Not surprisingly, this was a very young population; only 2% of participants was older than 60 years of age, and the average age was 27 years. This probably represents the first large-scale look into DED in the young; using a smartphone app clearly selected out the elderly.

What did they learn about those with severe symptoms in this new, modern DED population? Aging was inversely related to DED severity. In this population, there was more severe DED in younger individuals. Weird, huh? This probably corresponds to the increased risk associated with extended screen use times. Other risk factors are a little more in line with our usual suspects: Female sex, collagen disease, allergy, current contact lens use and smoking were all associated with a higher risk for severe DED symptoms.

When you look at a single disease in two very different groups, in this case the old and the young, you often discover stuff you don’t expect. For example, medical diseases such as hypertension, diabetes and hematologic diseases did not turn out to be risk factors in the young. The authors opine that this may reflect the difference between causative factors (eg, sex) and those that exacerbate existing disease. My take? Sex is the only constant across all ages. Otherwise, there are two routes to severe DED symptoms: aging and chronic disease, and lifestyle choices. The young likely have the same disease with the same pathophysiology (ocular surface inflammation); they just get there a different way.

Everything about DryEyeRhythm is cool. It’s easy to see how we could identify DED patients earlier using this type of outreach in the younger, more tech-savvy population. Perhaps this will allow us to diagnose and treat DED before symptoms become life altering.

*If you are using DryEyeRhythm in the U.S., please reach out to me.



Inomata, T. et al. Ophthalmology. 2019;doi:10.1016/j.ophtha.2018.12.013.

Disclosure: White reports he is a consultant to Allergan, Shire, Sun, Kala, Ocular Science, Rendia, TearLab, Eyevance and Omeros; is a speaker for Shire, Allergan, Omeros and Sun; and has an ownership interest in Ocular Science and Eyevance.