Highlights
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The Lebanese population is highly diagnosed with symptomatic DED.
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There is a statistical association between symptomatic DED and smoking in Lebanon.
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There is a statistical association between symptomatic DED and age in Lebanon.
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Lebanese smokers have higher prevalence of dry eye symptoms than the non-smokers.
Abstract
Purpose
To estimate the prevalence of symptomatic dry eye disease (DED) and investigate its associated risk factors in the Lebanese population.
Methods
Population-based cross-sectional study of 602 participants from Lebanon aged 18 years and older. Ocular Surface Disease Index (OSDI) questionnaire on dry eye symptoms was used to evaluate the prevalence of symptomatic DED. Chi-square test was used to investigate the association between DED status and risk factors such as age, gender and smoking tobacco.
Results
The percentage of DED among the study population (271 males and 331 females) was 36.4% with OSDI score ≥ 13 (mild to moderate and severe OSDI status). The most reported DED symptom in the population was sensitivity to light. Smokers reported higher DED symptoms than non-smokers. Older and smoker populations were more likely to report significantly higher OSDI scores (p < 0.05). Moreover, gender was not statistically associated with DED (p > 0.05).
Conclusion
Symptomatic DED is substantial in Lebanon. It is statistically associated with the age of population and their tobacco exposure.
1
Introduction
For a long time, dry eye disease (DED) was restricted to the symptoms of eye dryness caused by instability of the aqueous tear film. However, this definition outlines ineffectively the clinical representation of dry eye disease [ ]. Nowadays, the 2017 Tear Film and Ocular Surface Society – Dry Eye Workshop (TFOS DEWS II) Report has defined dry eye as “… a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.’’ [ ]
DED is widely diagnosed in ophthalmology with symptoms that have been found to be diminishing the patients’ capacity in performing their daily activities, and thus affecting their life quality. The epidemiological studies have estimated the prevalence range of DED between 5% and 50% in the studied populations where it is more common in elderly and females [ ]. Many risk factors could be associated with the increase of DED prevalence such as age, gender, contact lens wear, refractive surgery, diabetes, smoking and additional medications (e.g. anti-cholinergic, diuretics, β-blockers) [ , ].
A series of recent studies has estimated the worldwide prevalence of DED using the survey approach [ , ] or in conjunction with clinical signs and diagnostic approach [ , ]. Different assessment tools such as Ocular Surface Disease Index (OSDI), National Health and Wellness Survey, six-item questionnaire on symptomatic dry eye disease have been applied to assess qualitatively or quantitatively the epidemiology of DED [ ]. Moreover, the OSDI survey has shown simplicity and acceptable test-retest repeatability with high reliability and validity as an assessment tool of dry eye disease. It has also shown an effective discrimination between normal, mild to moderate, and severe DED using vision-related function, ocular symptoms and environmental triggers analysis [ ]. In the Middle East, the symptomology OSDI questionnaire has been applied in Jordan, Saudi Arabia and Lebanon [ , , ]. In the Jordanian study, the prevalence of DED among non-clinical population was estimated as 59% and the significant risk factors for DED were contact lens wear and age only [ ]. The Saudi Arabian study has also focused on OSDI with clinical examinations in order to assess the effect of indoor and outdoor environments on the DED among workers. On the other hand, the OSDI questionnaire has been utilized in Lebanon only to evaluate the severity of DED symptoms in glaucoma patients treated with different prostaglandin analogues rather than assessing the prevalence of DED among the general population [ ].
Lebanon is still in need for assessment of the prevalence of DED in order to begin the process of promoting awareness of DED in the Lebanese population and its associated risk factors. In the present study, the OSDI survey was applied for the first time on a sample of the general population of Lebanon in order to assess quantitatively the prevalence of symptomatic DED and identify the possible risk factors of DED.
2
Materials and methods
This cross-sectional study was conducted between July 2018 and January 2019 on the general population of Lebanon using the validated OSDI survey.
2.1
Population
The participants of the population were randomly selected from different Lebanese provinces and were asked to fill an online version of the questionnaire distributed throughout different online platforms. A total of 602 participants aged 18 years and older were asked to participate in this non-clinical study following the indication of the exclusion criteria for this study. The exclusion criteria included participants with eye surgeries, active ocular diseases, ocular or systemic medications which are known to interfere with tear film production or ocular surface integrity, and contact lens wearers.
2.2
Study tool
The OSDI questionnaire developed by the Outcomes Research Group at Allergan Inc. (Irvine, California) was applied in this study to provide a quantitative assessment of DED symptoms for the past week [ ]. The 12-item OSDI questionnaire includes three subscales: 5 questions to assess the ocular symptoms, 4 questions for the vision related function and 3 questions for the environmental triggers. Each item was graded on a scale of 0 to 4 that ranges from none of the time to all of the time. The total OSDI score was then calculated according to the following formula:
OSDIScore=Sumofscoresforallquestionsanswered×100Totalnumberofquestionsanswered×4
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