Beyond Digital Strain: Sleep Quality And Lipid Layer Patterns On Vistalipid In Symptomatic Dry Eye

To characterise objective tear film instability and VistaLipid lipid layer patterns in symptomatic dry eye disease (DED) and evaluate whether sleep quality shows a stronger association with lipid layer pattern distribution than screen exposure.

Private ophthalmology practice, specialized glaucoma and ocular surface unit.

Cross-sectional study of 34 patients (68 eyes; mean age 42.03±8.07 years). Symptoms were graded with the Ocular Surface Disease Index (OSDI). Sleep quality was screened using a short adapted Pittsburgh Sleep Quality Index (PSQI) plus nocturnal habits and screen-time category. Objective testing included VistaLipid interferometry (Types I–IV), tear break-up time (TBUT; <5 s, 5–10 s, >10 s) and tear meniscus height. Eye-level findings were summarised descriptively. To avoid inter-eye dependence for patient-level variables, associations were explored at patient level using the best-eye VistaLipid grade per patient (Spearman correlation; Mann–Whitney U).

Female sex predominated (32/34, 94.1%). Screen use was reported by 33/34 (97.1%); 12/34 (35.3%) reported >8 h/day. OSDI was severe in 26/34 (76.5%) and moderate in 7/34 (20.6%); poor PSQI occurred in 19/34 (55.9%). TBUT was <5 s in 54/68 eyes (79.4%) and 5–10 s in 14/68 (20.6%); no eye exceeded 10 s. VistaLipid types were: IV 19/68 (27.9%), III 23/68 (33.8%), II 23/68 (33.8%), I 3/68 (4.4%). Poor PSQI correlated with a lower (more Type IV) best-eye VistaLipid grade (rho=−0.424, p=0.012), whereas screen-time category was not significant (rho=0.269, p=0.123). Type IV eyes frequently still had TBUT <5 s (18/19, 94.7%).

In this symptomatic cohort, objective tear film instability was near-universal and VistaLipid patterns clustered mainly in Types II–IV. Sleep quality showed a significant association with lipid layer pattern distribution beyond screen exposure, highlighting a behavioural axis relevant to DED phenotyping. The frequent coexistence of a Type IV pattern with very short TBUT suggests lipid morphology alone may not predict functional tear stability, supporting combined assessment (sleep screening plus objective tear metrics) to stratify risk and guide personalised ocular surface optimisation. Larger prospective studies are warranted.