Depression and dry eye disease: a need for an interdisciplinary approach?

A recent meta-analysis including data from 22 studies including 2.9 million patients found that anxiety and depression are more prevalent in patients with dry eye disease (DED) than in controls. DED is a common disorder of the tear film which can cause ocular irritation, foreign body sensation and visual disturbance. However there is often a great discrepancy between signs and symptoms of DED, which the symptoms often being more associated with non-ocular disorders such as depression and PTSD than to tear film parameters. In this way it could be considered as more of a psychiatric than ophthalmic complaint. DED and depression feedback on one another in a synergistic manner. Severity of DED is associated with symptoms of anxiety and depression. Treatment of DED could help reduce depression symptoms, but also effective management of depression could help alleviate symptoms of DED. Complicating this however is the evidence that SSRIs can exacerbate DED. This makes the management of these comorbidities more difficult, however there are putative therapeutic targets which may be a source of future treatments for DED-associated depression. In conclusion, it is clear that DED and depression are closely linked and influence one another in ways that drastically affect patients' lives. Collaboration between psychiatrists and ophthalmologists could be beneficial in the management of those with DED.

Ethical and Organisational considerations in screening for dementia.

The United Kingdom National Screening Committee (UKNSC) defines screening as "the process of identifying individuals who may be at higher risk of a disease or condition amongst large populations of healthy people". Building on foundations laid by Wilson and Jungner in the landmark paper in 1968, the UKNSC states that "Once identified, those individuals can consider further tests, and healthcare providers can offer them interventions of benefit. A screening programme needs to offer more benefit than harm, at a reasonable cost to the NHS" (gov.uk 2014). We will consider the ethical issues surrounding some of the UK's screening programmes and other methods used to assess and communicate patients' risk of disease. We will discuss the appropriateness of candidate dementia biomarkers in order to inform research into developing such a biomarker or series of biomarkers.