Elsevier

The Ocular Surface

Volume 18, Issue 4, October 2020, Pages 808-813
The Ocular Surface

Characterising the ocular surface and tear film in a population-based birth cohort of 45-year old New Zealand men and women

https://doi.org/10.1016/j.jtos.2020.08.005Get rights and content

Abstract

Purpose

To assess the prevalence of dry eye disease, aqueous tear deficiency, meibomian gland dysfunction, and asymptomatic ocular surface disease in a population-based cohort of 45-year-old New Zealand men and women.

Methods

This cross-sectional study of 885 participants (442 females, 443 males) was based on a population-representative birth cohort of individuals born between April 1 1972 and March 31 1973 in Dunedin, New Zealand (the Dunedin Multidisciplinary Health and Developmental Study). Participants were assessed at 45 years of age, and dry eye symptomology, ocular surface characteristics, and tear film quality were evaluated for each participant within a single clinical session. The diagnosis of dry eye disease was made according to the validated rapid non-invasive dry eye assessment algorithm.

Results

Clinical dry eye signs were present in 402 (45%) participants, of which 78 (9%) participants fulfilled the diagnostic criteria for dry eye disease, and 322 (37%) had asymptomatic ocular surface disease. Among participants with dry eye disease, 22 (2%) exhibited aqueous tear deficiency, and 65 (7%) had meibomian gland dysfunction. Females were more likely to be affected by dry eye disease, meibomian gland dysfunction, and asymptomatic ocular surface disease (all p < 0.05).

Conclusions

Clinical dry eye signs were present in almost half of this population-based cohort of 45-year-old New Zealanders, although only 9% of participants fulfilled the diagnostic criteria for dry eye disease. The high prevalence of asymptomatic ocular surface disease presents an opportunity for preventative public health intervention.

Introduction

Dry eye disease is a complex multifactorial ophthalmic condition affecting the ocular surface, characterised by homeostatic disturbance of the tear film [1,2]. The condition can be associated with significant effects on ocular comfort, quality of life, visual function, and work productivity [1,[3], [4], [5]]. In the United States, the total estimated societal expenditure related to dry eye disease, including physician visits, therapeutic management, productivity loss, and other associated costs, exceeds US$55 billion per year [6].

Dry eye disease is classified into two etiological subtypes, aqueous tear deficiency and evaporative disease, of which the latter is more common and frequently associated with underlying meibomian gland dysfunction [1,2,7]. Irrespective of etiological subtype, a common pathway of tear film instability, hyperosmolarity, and ocular surface inflammation is triggered [2]. In recent years, there has also been growing recognition of asymptomatic ocular surface disease, defined by the presence of dry eye signs in the absence of symptoms, which might indicate neurotrophic conditions or represent a prodromal state with increased susceptibility to future development of more significant dry eye disease [1,2].

The recent Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) Epidemiology Report highlighted the paucity of epidemiologic data on the population prevalence of dry eye disease in the Southern Hemisphere over the past decade [3]. The purpose of this cross-sectional study was to assess the prevalence of dry eye disease, aqueous tear deficiency, meibomian gland dysfunction, and asymptomatic ocular surface disease in a population-based cohort of 45-year-old New Zealand men and women, using the rapid non-invasive dry eye assessment algorithm, which has been previously validated against the global consensus TFOS DEWS II diagnostic battery and subclassification testing scheme for dry eye disease [8,9].

Section snippets

Participants

This cross-sectional study adhered to the tenets of the Declaration of Helsinki, and was approved by the Health and Disability Ethics Committees, Ministry of Health, New Zealand. Participants were members of the Dunedin Multidisciplinary Health and Development Study, a longitudinal study of the health and behaviour of a population-representative birth cohort of individuals born between April 1 1972 and March 31 1973 in Dunedin, New Zealand (the Dunedin Multidisciplinary Health and Developmental

Results

Ocular surface characteristics of the 885 participants (442 females and 443 males) are presented in Table 3, and Fig. 1, Fig. 2, Fig. 3, Fig. 4. Overall, clinical dry eye signs were present in 402 (45%) participants, of which 78 (9%) participants fulfilled the diagnostic criteria for dry eye disease, and 322 (37%) had asymptomatic ocular surface disease (Table 1, Fig. 1).

Among participants with dry eye disease, 22 of 78 (28%) exhibited aqueous tear deficiency, and 65 of 78 (83%) had meibomian

Discussion

This study showed that dry eye disease was present in 9% of the population-based cohort of 45-year-old New Zealand men and women. This is comparable to the prevalence rates reported by the meta-analysis conducted by the TFOS DEWS II Epidemiology Subcommittee, which showed that between 8 and 15% of adults between the age of 40–49 fulfilled the Women's Health Study (WHS) criteria or had been clinically diagnosed with dry eye disease [3]. Interestingly, the prevalence of dry eye disease reported

Conclusions

In conclusion, this study sought to address the paucity of epidemiologic data in the Southern Hemisphere by assessing the prevalence of dry eye disease in a population-based cohort of 45-year-old New Zealand men and women. The results show that clinical dry eye signs were present in just under half of participants, although only 9% of participants fulfilled the rapid non-invasive diagnostic criteria for dry eye disease. The high population prevalence of asymptomatic ocular surface disease may

Funding

The Dunedin Multidisciplinary Health and Development Research Unit is supported by the New Zealand Health Research Council, and has also received funding from the New Zealand Ministry of Business, Innovation and Employment. This research also received support from the New Zealand Health Research Council Programme Grant (16–604). The authors thank the Rapanui Trust, Gisborne, New Zealand for funding the Oculus Keratograph 5M. The funding sources had no role in the design and conduct of the

Declaration of competing interest

The authors have no commercial or proprietary interest in any concept or product described in this article.

Acknowledgements

We thank the Dunedin Study members, their families and friends for their long-term involvement, as well as Dunedin Unit Director, Richie Poulton; Dunedin Unit research staff; and Study founder, Phil A. Silva.

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