The Epidemiology of Dry Eye Disease

Authors

Study duration

Region/country

Population studied

Age (years)

Definition

Denominator

Prevalence

95 % CI

Schein et al. (1997)

1993–1995

USA

2,420 participants in the Salisbury Eye Study

65≤

At least one (of six) symptoms occurring often or always

2,420

14.6 %

13.2–16.0 %

McCarty et al. (1998)

Australia

926 participants in the Melbourne Visual Impairment project. 493 females, 433 males

40≤

At least one (of six) symptoms (not attributed to hay fever) rated as severe

926

Symptoms 5.5 %

4.0–7.0 %

1.5–16.3 % objective tests

Moss et al. (2000)

1995–2005

USA

3,722 participants in the 5- and 10- year Beaver Dam Eye Study

63 ± 10 (48–91)

Self-report to questions “For the past 3 months or longer have you had dry eyes?”

2,414 (44 % men)

All subjects 21.6 %

19.9–23.3 %

48–59 17.3 %

80<28.0 %*

Men 17.2 %

Women 25.0 %*

Chia et al. (2003)

1999–2001

Australia

1,174 participants in the Blue Mountains Eye Study

60.8 (50–90)

At least one (of 4) symptoms, regardless of severity or at least 1 symptom rated either moderate or severe

1,075

16.6 % (at least one symptom)

14.3–18.7 %

15.3 % (3 or more symptoms)

13.1–17.5 %

Schaumberg et al. (2003)

1992–1996

USA

38,124 female participants in Women’s Health Study

49–89

History of clinically diagnosed DED or severe symptoms constantly or often

36,995

7.8 % (age adjusted prevalence for women over 50)

7.5–8.1 %

Schaumberg et al. (2009)

1997–2004

USA

25,444 men, participants in Physicians Health Studies I or II

64.3 (50–90)

Clinically diagnosed dry eye or severe symptoms (both dryness and irritation constantly or often)

25,444

Men 4.3 %

4.1–4.5 %

50–54 3.9 %

3.7–4.1 %

80<7.7 %*

Galor et al. (2011)

2005–2010

USA

Data extracted from the Miami and Broward Veterans Affairs database. Total 16,862

21–90

International Classification of Disease, 9th edition, Clinical Modification (ICD-9-CM) code 375.15

16,862

All subjects 10 %

9.5–10.5 %

Male 12 %

Female 22 %

Viso et al. (2012)

2005–2006

Spain

1,155 from National Health Service Registry

63.6 ± 14.4 (40–96)

Symptoms and at least one of Schirmer test score ≤5 mm, TBUT ≤10 s, fluorescein staining score ≥1, and rose bengal score ≥3

654 (32.7 % 243 males, 411 females 62.8 %)

All subjects 11 %

8.6–13.3 %

Paulsen et al. (2014)

2005–2008

USA

3,275 Beaver Dam Offspring Study (BOSS) participants. 1,789 females (54.9%)

21–84

Self-report of frequency and the intensity of symptoms and use of eyedrops at least once a day

3,275

14.5 %

13.3–15.7 %

Men 10.5 %

Women 17.9 %

Lee et al. (2002)

2001

Indonesia

1,058 selected from 100 households, predominantly rural population

21≤

At least one (of six) symptoms often or all of the time

1,058

Age adjusted rate 27.5 %

24.8–30.2 %

21–29 19.2 %

15.0–23.5 %

60<30.0 %

20.1–39.5 %

Lin et al. (2003)

1999–2000

Taiwan

2,038 participants in the Shihpai Eye Study

65≤

At least one (of 6) symptoms often or all of the time

1,361

33.7 %

32.4–34.9 %

Han et al. (2011)

2008–2009

Korea

657 (317 males (48.2%), 340 female (51.8%)). 346 urban and 311 rural participants

72 (65–95)

One + symptoms of dry eye often or most of the time, and at least one of: TBUT ≤10 s, Schirmer score ≤5 mm, and corneal staining ≥ grade 1

657

Age, gender, rural adjusted 33.2 %

28.8–37.3 %

Jie et al. (2009)

2001

Beijing, China

4,439 previous participants in the Beijing Eye study 2001

57 (40–84)

One + of the following: TBUT ≤10 s; Schirmer ≤5 mm; fluorescein staining ≥1, lid margin telangiectasia; and/or plugging of the gland orifices. OR TBUT ≤4 s or Schirmer ≤4 mm, or fluorescein staining ≥2

1,957 (1,112 females)

21 %

19.2–22.8 %

Zhang et al. (2012)

2010

Shandong, China

1,902 senior high school students

Either a previous diagnosis of DES or severe symptoms (both dryness and irritation constantly or often) per Schaumberg et al. (2003)

1,885 (958 male, 927 female)

23.7 %

21.8–25.6 %

Guo et al. (2010)

Jun–Sep 2006

Mongolia

2,112 native Mongolians (1,125 male (53.3%))

54.9 ± 11.7 (40–91)

One or more symptoms often or all the time

1,816

50.1 %

47.8–52.4 %

Uchino et al. (2011)

Feb – Mar 2010

Japan

3,294

40– ≥80

Severe symptoms of DED (both ocular dryness and irritation either constantly or often or clinically diagnosed DED as reported by participants

2,644 (1,211 men and 1,423 women)

21.6 % women

19.5–23.9 %

12.5 % men

10.7–14.5 %

Uchino et al. (2013)

Japan

561 Japanese young and middle aged office workers using VDTs

22–65

One or more symptoms of dry eye often or most of the time, and at least one of: TBUT ≤10 s, Schirmer ≤5 mm, and fluorescein staining ≥ grade 1

561 Office (187 women, 374 men)

18.7 % (women)

13.4–25.1 %

8.0 % (men)

5.5–11.3 %

Shaded studies represent those carried out in Asian populations

TBUT tear breakup time

*Statistically significant effect of age or gender

Prevalence estimates of MGD have been similarly confounded by the lack of a standardized definition and standardized method for grading MGD (Schaumberg et al. 2011). There are also no standardized questionnaires available for MGD; symptoms frequently overlap with those reported in dry eye disease and/or anterior blepharitis, and the disease is frequently asymptomatic (Viso et al. 2012). Estimates of prevalence from population-based studies have varied widely from 3.5 to 68.3 % (Schein et al. 1997; Jie et al. 2008; Siak et al. 2012).

Table 2.2 summarizes the key population studies and their disease definitions. Key features are firstly that lower prevalence rates have been published in studies where symptoms were not included as part of the disease definition. The clinical signs used as part of the diagnostic criteria have also varied widely, with some studies focusing on secondary outcomes such as measures of tear quality or tear stability and others on specific but varied lid signs. The relatively high prevalence rate of 68 % from the Beijing Eye Study, for example, is consistent with a definition that included clinical signs of lid disease and symptoms of dry eye. Secondly, the prevalence data appears to be consistently higher in studies of Asian populations compared with reports where the majority of participants are Caucasian for broadly similar disease definitions and sampling techniques (Schein et al. 1997; Lin et al. 2003; Uchino et al. 2011; Siak et al. 2012; Viso et al. 2012).

Table 2.2

Prevalence of evaporative dry eye