Mitigating the Dry Eye Disease Burden by Improving Indoor Air Quality - Mitigating the Dry Eye Disease Burden by Improving Indoor Air Quality Background. Dry eye disease (DED) is a complex, multifactorial condition affecting up to 30% of the global population. Its onset and severity are influenced by a range of factors, including genetics, diet, comorbidities, and environmental conditions. Despite advances in treatment therapies, managing DED remains challenging. Our ongoing research (R01 EY026174) indicates that indoor air quality (IAQ) is significantly associated with DED signs and symptoms (DED-SS). The type and severity of DED-SS vary depending on the level and nature of environmental stressors (ES), such as reactive gases, particulate matter (PM), aeroallergens, and meteorological conditions. Rationale. Although air purifiers can reduce indoor PM, they are insufficient to address the full spectrum of ES, including aeroallergens, volatile organic compound (VOC) and heat stress. Moreover, the role of air purifier interventions in mitigating DED-SS remains unclear. We hypothesize that low-cost multimodal interventions (LCMI) can reduce exposure to multiple ES, thereby will alleviate DED symptoms and lower associated healthcare costs. Study design. We will use a randomized controlled crossover trial involving 360 adults with DED-SS in Miami- Dade County. Participants will be randomly assigned (1:1) to one of two study arms of the study (P1 and P2), stratified by age, race/ethnicity, and gender. Each participant will be followed for nine months, with assessments at baseline (t0), 6 months (t1), and 12 months (t2). At each time point, we will collect blood, conjunctival, and meibum samples, assess DED-SS, and document comorbidities, medication use, and healthcare utilization. We will track their weekly DED symptoms via automated text messaging. IAQ will be continuously monitored using real-time sensors installed in participants' homes. LCMI will be implemented at baseline (t0) in P1 and at 6 months (t1) in P2. The LCMI will consist of a) an air purifier with an activated carbon filter to reduce airborne particulate and gaseous pollutants, b) a dehumidifier to control relative humidity (RH), c) one indoor plant per 800 ft2 of living space, and d) replacement filters for six months. Outcomes: Our primary outcome is DED status, assessed using the 5-Item Dry Eye Questionnaire (DEQ5), with a score <8 indicating no DED. Our secondary outcomes include other DED-SS and associated healthcare costs. We will model these outcomes before and after the interventions at six and 12 months adjusting for potential confounders, and also across two arms at six months when P2 will serve as a control. Community Impact: In collaboration with local organizations and health fairs, we will disseminate our findings and provide IAQ education and free vision screenings. We anticipate that the benefits of LCMI will extend beyond DED, positively impacting other comorbidities and the health of household members.
