Characterising the ocular surface and tear film in a population-based birth cohort of 45-year old New Zealand men and women
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.
References (38)
- et al.
TFOS DEWS II definition and classification report
Ocul Surf
(2017) - et al.
TFOS DEWS II pathophysiology report
Ocul Surf
(2017) - et al.
TFOS DEWS II epidemiology report
Ocul Surf
(2017) - et al.
TFOS DEWS II pain and sensation report
Ocul Surf
(2017) - et al.
Screening utility of a rapid non-invasive dry eye assessment algorithm
Contact Lens Anterior Eye
(2019) - et al.
TFOS DEWS II diagnostic methodology report
Ocul Surf
(2017) - et al.
Randomized double-masked trial of eyelid cleansing treatments for blepharitis
Ocul Surf
(2018) - et al.
Comparison of subjective grading and objective assessment in meibography
Contact Lens Anterior Eye
(2013) - et al.
Natural history of dry eye disease: perspectives from inter-ethnic comparison studies
Ocul Surf
(2019) - et al.
Ethnic differences between the Asian and Caucasian ocular surface: a co-located adult migrant population cohort study
Ocul Surf
(2019)
Exploring the Asian ethnic predisposition to dry eye disease in a pediatric population
Ocul Surf
Exploring the predisposition of the Asian eye to development of dry eye
Ocul Surf
Relation between signs and symptoms of dry eye in the elderly. A population-based perspective
Ophthalmology
TFOS DEWS II management and therapy report
Ocul Surf
Impact of blinking on ocular surface and tear film parameters
Ocul Surf
Temperature profiles of patient-applied eyelid warming therapies
Contact Lens Anterior Eye
Randomised trial of the clinical utility of an eyelid massage device for the management of meibomian gland dysfunction
Contact Lens Anterior Eye
TFOS DEWS II sex, gender, and hormones report
Ocul Surf
Functional impairment of reading in patients with dry eye
Br J Ophthalmol
Cited by (9)
Meibomian Gland Dysfunction and Dry Eye Disease
2022, Dry Eye DiseaseModifiable lifestyle risk factors for dry eye disease
2021, Contact Lens and Anterior EyeCitation Excerpt :Indeed, dry eye disease is acknowledged to be an age-related, degenerative condition, which progresses with cumulative lifetime exposure to various environmental and physiological factors, that culminate in neurosensory abnormalities, hormonal changes, tear film homeostatic disturbances, and ocular surface inflammation [1,4,7,24]. The association between female sex and dry eye disease has been hypothesised to be partially attributed to the complex inter-relationships between the regulatory action of sex steroids, hypothalamic-pituitary and thyroid hormones on the immune system and ocular surface [1,25,26]. The East Asian ethnic propensity to dry eye development has been hypothesised to be related to anatomical differences in orbital structure that predispose to increased eyelid tension, incomplete blinking and accelerated rates of meibomian gland dropout [17,20,27].
Bidirectional association between atopic dermatitis, conjunctivitis, and other ocular surface diseases: A systematic review and meta-analysis
2021, Journal of the American Academy of DermatologyCitation Excerpt :Studies mainly relied on self-reports, and the prevalence estimates tended to be lower when the analyses were restricted to studies with clinically diagnosed AD and conjunctivitis. A study of dry eye disease found that only 9% of those with clinical dry eye signs fulfilled the diagnostic criteria for dry eye disease according to the validated rapid noninvasive dry eye assessment algorithm.61 Few studies provided data concerning disease phenotypes or OSDs other than conjunctivitis, resulting in wide confidence intervals.
Sex Differences in the Prevalence of Meibomian Gland Dysfunction: A Mini Review
2024, Current Eye ResearchThe Effects of Fisetin on Cyclosporine-Treated Dry Eye Disease in Dogs
2023, International Journal of Molecular Sciences
- 1
Joint first authors.