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Prevalence of Dry Eye Disease and its Risk Factors in Visual Display Terminal Users: The Osaka Study
Abstract
To investigate tear function and prevalence of dry eye disease (DED) in visual display terminal (VDT) users.
Cross-sectional study.
Six hundred and seventy-two young and middle-aged Japanese office workers who used VDT completed questionnaires and underwent dry eye testing. We estimated the prevalence of DED using logistic regression analysis to examine associations between DED and possible risk factors. The ocular surface feature, prevalence of DED, and risk factors were evaluated.
Of the 672 workers, 561 (83.5%, mean age: 43.3 ± 9.1 years) completed the questionnaire. The percentage of women with a composite outcome of definite DED or probable DED was 76.5%, which was higher than that among men (60.2%; odds ratio [OR] = 2.00; 95% confidence interval [CI], 1.29-3.10, P = .002). Workers over 30 years of age had a higher risk of DED (OR = 2.22; 95% CI, 1.06-4.66), as did workers using a VDT >8 hours per day (OR = 1.94; 95% CI, 1.22-3.09). Average Schirmer value was 18.7 ± 11.7 mm and tear break-up time (TBUT) was 4.0 ± 2.5 seconds (78.6% of study participants had TBUT ≤5 seconds).
DED is prevalent among young to middle-aged Japanese VDT users. Ophthalmic findings revealed short TBUT and corneal staining accompanied by normal Schirmer test values. Increased risk for DED was noted for women aged over 30 years and prolonged VDT use. Measures to modify the adverse impact of VDT use on the ocular surface may provide a positive impact on public health and quality of life for office workers using VDTs.
... As digital engagement has become increasingly embedded in professional and personal spheres, the need for targeted strategies to mitigate its impact on ocular health has become essential. Understanding and addressing the underlying causes of screen-induced visual discomfort is crucial for improving both physical well-being and workplace productivity, highlighting the urgent need for strategies to protect ocular surface health in the digital era [4]. The World Health Organization's (WHO) global strategy on digital health of 2020- ...
... Several studies have reported that digital screen use is associated with reduced blink rates and completeness [4,30]. For instance, Patel et al. observed a reduction from a baseline value of 18.4 blinks/min to 3.6 blinks/min during computer use [29]. ...
... A reduced blink rate and completeness can have an impact on DED. The Osaka crosssectional study, which recruited 561 patients aged 22-65 years with a mean videoterminal use of 7.9 h/day, reported an increased incidence of DED signs, as shown by alterations in both the Schirmer test and tear breakup time (TBUT) and the presence of ocular surface epithelial damage [4]. ...
Dry eye disease (DED) has become increasingly prevalent in the digital era, largely due to prolonged screen exposure. The excessive use of digital devices contributes to inappropriate blink frequency and dynamics, leading to ocular surface dryness and discomfort. Additionally, digital screen use has broader implications for systemic health, including visual strain, headaches, and disrupted circadian rhythms caused by blue light exposure. Previous studies have shown that prolonged screen time correlates with altered blink frequency and increased symptom severity in DED patients, exacerbating the imbalance in tear film production and evaporation. Blinking dynamics, particularly blink rate and completeness, are crucial in maintaining ocular surface moisture. Incomplete blinking impairs meibomian gland function, reducing lipid secretion, which is essential for preventing tear evaporation. Raising patient awareness through educational material, ergonomic adjustments, and blinking exercises has been shown to mitigate these effects. Digital tools that provide targeted educational interventions can be particularly effective in improving blink dynamics and overall ocular comfort. This study evaluates the efficacy of digital applications in optimizing blinking dynamics and enhancing tear film stability. The findings suggest that these innovations improve patient outcomes by encouraging healthier eye care practices. However, further research is needed to assess their long-term impact across diverse populations.
... This association is likely due to the influence of female hormones, particularly androgens, on tear secretion via the meibomian and lacrimal glands [34,46]. Advanced age was also shown to be an important factor in two studies included in this review [30,33], advanced age was also shown to be an important factor in two studies included in this review [44,[47][48][49] that link age-related decline in tear gland function to DED [43,50,51]. While not explicitly identified in this review, environmental factors such as humidity and climate have been associated with DED in other regions [52][53][54][55], indicating the need for further research on these factors in South America. ...
... This was especially evident in studies involving populations more frequently exposed to screens, such as administrative workers or university students [18,25,26,29]. This relationship has been widely supported by other re-search [15,47,49,50], with the effect attributed to increased tear evaporation due to reduced blinking. These findings are particularly relevant given the global trend towards increased use of electronic devices [62,63]. ...
... Although this risk factor is not commonly reported, it has been previously identified in some populations, such as older adults or chronic smokers [75][76][77][78]. However, other studies have rejected this association [49,74,79]. ...
Background/Objectives: Dry eye disease is a leading cause of ophthalmologic consultations worldwide and can significantly impact quality of life. While global prevalence rates vary widely, data specific to South America are limited. This systematic review aims to describe and analyze the prevalence and associated factors of dry eye disease-related symptoms in South American populations. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted using databases such as PubMed, Web of Science, Scopus, and LILACS. Primary studies in English and Spanish that examined the prevalence of dry eye disease-related symptoms in South American populations and its associated factors were included without date restrictions. Studies were screened and selected based on predefined inclusion and exclusion criteria, resulting in the final inclusion of 16 studies from six South American countries. Results: This review identified significant variability in the prevalence of dry eye disease-related symptoms in South American populations in the region, ranging from 4% to 77.5%, with a mean prevalence of 39.3%. Higher prevalence rates were observed among specific groups, such as university students (58.6%) and administrative workers (57.9%). Factors associated with dry eye disease-related symptoms in South American populations included female sex, older age, prolonged screen time, insufficient sleep, and medical conditions such as hypertension, connective tissue disorders, and the use of medications like antihypertensives and antidepressants. Conclusions: The prevalence of dry eye disease-related symptoms in South American populations is notably higher than global averages, highlighting regional challenges. This study emphasizes the need for standardized diagnostic tools and comprehensive epidemiological research across South America, particularly in underrepresented countries, to inform public health strategies tailored to the specific needs of these populations.
... DED is an inflammatory disease with reduced tear film amount and quality. Common DED symptoms include dryness, grittiness, foreign body sensation, discharge, soreness, fatigue, intermittent blurry vision and unspecific ocular discomfort [14]. DED in most VDT users is characterized by a moderate-to-severe ocular surface disease index, high tear osmolarity, lacrimal hypofunction, epithelial defects of the cornea and conjunctiva, and meibomian gland dysfunction (MGD) [2,[13][14][15][16]. ...
... Common DED symptoms include dryness, grittiness, foreign body sensation, discharge, soreness, fatigue, intermittent blurry vision and unspecific ocular discomfort [14]. DED in most VDT users is characterized by a moderate-to-severe ocular surface disease index, high tear osmolarity, lacrimal hypofunction, epithelial defects of the cornea and conjunctiva, and meibomian gland dysfunction (MGD) [2,[13][14][15][16]. In a recent study, impaired blinking patterns and change in parasympathetic signaling were proposed as a pathophysiology of DED in VDT users [17]. ...
... In a recent study, impaired blinking patterns and change in parasympathetic signaling were proposed as a pathophysiology of DED in VDT users [17]. Osaka et al. reported that ≥60% of VDT users had DED with a decreasing tear film break-up time (TBUT) [14] and that MGD developed in >20% of VDT users and decreasing TBUT and MGD would imply evaporative DED [14]. Also, the ocular surface damage and irritation resulting from DED significantly impair the quality of life (QoL) [18,19]. ...
We aim to evaluate the effectiveness of an acupuncture steam-warming eye mask (ASEM) on dry eye disease (DED) in visual display terminal (VDT) users. This prospective randomized clinical trial included VDT users with DED-related features who were randomly assigned to the ASEM group (ASEM for 2 weeks, 20 participants) or the steam-warming eye mask (SEM) group (SEM for 2 weeks, 20 participants). The tear film break-up time (TBUT), Schirmer test, tear meniscus height, ocular surface staining scores, eyelid and meibomian gland exam, subjective symptoms, and quality of life (QoL) scores before and after treatment were collected. A generalized linear mixed model was applied to compare the improvement of symptoms and signs between the two groups. After the 2-week treatment, all the subjective symptoms and questionnaire scores in the ASEM group improved significantly (all p < 0.05), whereas the feelings of relaxation, comfortable, and refreshment did not change in the SEM group (both p > 0.05). The TBUT, tear meniscus height, and meibum quality in the lower eyelid were significantly better in the ASEM group than the SEM group (all p < 0.05), whereas no significant changes were observed in the Schirmer test and ocular surface staining scores. Compared with the SEM group, the ASEM group experienced a stronger feeling of refreshment (p = 0.013), lower sensation of ocular discharge (p = 0.031), higher TBUT (p = 0.045), better meibomian gland expressibility of both eyelids (both p < 0.05), and better meibum quality of both eyelids (both p < 0.05), even after adjustments for age and sex. In conclusion, comparing with SEM, ASEM can improve some subjective DED symptoms, tear film stability, and meibum status in VDT users.
... Comparing the result in this study with hospital-based studies: study in south east Nigeria observed that gender was not associated with dry eye disease while another in India observed that males were more associated with dry eye in the ratio of 2.3:1 [27,30] . Comparing the result in this study with population-based studies, a study in Iran and Beijing Eye Study observed that gender was associated with dry eye [22,33] . It was observed in this study that age was not a risk factor for DED using any of the three evaluation parameters and this was presumably because this study included participants of younger age and also because of the restricted age range. ...
... Some hospital-based studies using different methodologies, different study population and different definitions for dry eye had shown that age was not a predictor for DED while some studies in south-east Nigeria , , India showed that age was associated with dry eye [27,30] . Some population-based studies in Iran, and Korea using different methodologies, different study population and different definitions for dry eye had also shown that age was not associated with DED while some studies, Blue Mountains Eye Study, Beijing Eye Study showed that age was associated with dry eye [22][23][33][34] . The use of computers has between two-and three-fold risk effect in the onset of DED using OSDI score but does not have a risk effect when analysed with Schirmer 1 test and TBUT. ...
... Excessive use of VDTs has been noticed to enhance ocular discomfort due to the alteration of different LFU structures [6,11,[38][39][40][41][42]. Authors have identified a clear relationship between high exposure to VDTs and sleeping problems and obesity due to digital addiction [43,44]. ...
... Authors have identified a clear relationship between high exposure to VDTs and sleeping problems and obesity due to digital addiction [43,44]. Regarding ocular health, previous reports have identified diminished tear film stability values after long periods of screen use, independent of the measurement technique performed by the researchers, such as Non-Invasive Break-Up Time or FBUT [6,38,39,41,42]. The alteration of tear film stability results from a reduced blinking rate that occurs during activities requiring focus, such as screen use [6,11,42,45]. ...
Purpose: To evaluate how Video Display Terminal (VDT) use, Contact Lens (CL) wear, and eyedrop use affect ocular surface parameters in participants with ocular discomfort and how these factors may vary across different age groups. Methods: The current cross-sectional study initially involved a total of 252 participants who completed a self-administered survey to collect information about ocular discomfort and lifestyle factors. This online survey was composed of an Ocular Surface Disease Index (OSDI) questionnaire and three extra questions regarding lifestyle factors (VDT use, CL wear, and eyedrop use). Only 185 symptomatic participants, those with OSDI values > 12, were scheduled to undergo a comprehensive ocular examination that included tear film osmolarity, Fluorescein Break-Up Time (FBUT), Maximum Blink Interval (MBI), and corneal staining. Results: Differences in ocular parameters and lifestyle factors across age groups (<40 years, 40–60 years, >60 years) were analyzed, along with their correlations and regression. Significant age group differences were found in OSDI, osmolarity, FBUT, and MBI (One-way ANOVA, all p ≤ 0.029). Correlations were observed between CL wear and osmolarity and MBI (Pearson’s correlation, both p ≤ 0.049). Multiple regression confirmed age associations with OSDI, osmolarity, FBUT, and MBI (Multiple linear regression, all p ≤ 0.040) and found links between VDT use and osmolarity and MBI (Multiple linear regression, both p ≤ 0.038) and between eyedrop use and OSDI (Multiple linear regression, p = 0.040). Conclusion: Aging is a primary factor affecting ocular homeostasis, with older adults showing lower FBUT and MBI values and higher osmolarity. Prolonged use of VDTs exacerbates this effect, further contributing to ocular discomfort and destabilized tear film. No associations between CL wear and any of the ocular parameters were found. Eyedrop use shows varied effects on ocular comfort across age groups, emphasizing the need for age-specific ocular care. Overall, these findings confirm that aging and extended VDT use play a significant role in ocular surface discomfort.
... 6 The Osaka study which was conducted in Japan showed a high prevalence of DED among young to middle aged Japanese workers using VDT. 7 In other studies, multiple risk factors for DED have been studied along with VDT use in different age groups. VDT use has been on the rise in young individuals who are using them for prolonged hours. ...
... 89.98% of the study population with 4 hours or more of VDT use had severe dry eye (adjusted OR 60.2; 95% confidence interval [CI] 43.9-82.7). 7 In a study conducted in middle-aged office workers of Japan, prolonged VDT use >8 hours (vs short VDT use, i.e <8 hours, OR 1 4 1.94, 95% CI 1 4 1.22-3.09, P 1 4 .005) ...
To study the prevalence of Dry Eye Disease (DED) among undergraduate medical students using Visual Display Terminal (VDT).
: Cross-sectional study was conducted on 444 students at Medical college Hospital in the department of Ophthalmology. All the consented study participants, after ruling out the exclusion criterion, underwent dry eye workup which included routine slit lamp examination and Tear film break up time (TBUT). In this study, TBUT ≤ 10 seconds was considered abnormal. They were asked to fill out an OSDI (Ocular Surface Disease Index) questionnaire (Allergen Inc, Irvine, Calif, USA). The participants were asked to answer questions related to VDT use. Statistical analysis was done using the SPSS software (IBM).
Based on the OSDI questionnaire, clinically significant DED was found in 28.8%. DED was classified as mild DED in 17.1%, moderate DED in 6.3% and severe DED in 5.4% of the participants. Among those with DED, VDT use was 2 to 4 hours in 29% of the participants, VDT > 4 hours was seen in 32.7% of participants. Thereby, indicating that increase in VDT use had an association with increase in prevalence of DED. DED based on signs (TBUT< or = 5 sec) was observed in 86.3% of participants.
: There is a statistically significant association between VDT use and DED among young students.
... The loss of tear film homeostasis, which is a crucial protective and refractive layer for the ocular surface, is a hallmark of dry eye illness. As a result, this instability may worsen patients' quality of life and ability to do their jobs professionally by causing visual impairment, eye pain, ocular surface inflammation, and even corneal perforation in those with dry eye disease as well as bringing a great burden to both medical security and socioeconomic systems (Uchino et al., 2023). ...
... According to Uchino et al. (2023), two major factors contributing to dry eye include prolonged gazing and high tear evaporation from electronic screens. DE is a multifactorial ocular surface illness that is typified by dyshomeostasis of the tear film and related symptoms such as inflammation, injury, and anomalies in the nervous system of the eyes. ...
... [9] Uchino et al. observed that VDT workers had short TBUT and increased corneal fluorescent staining, despite normal lacrimal function. [20] Decreased blink rate and increased interpalpebral ocular surface area during the use of VDTs may increase tear evaporation due to destabilization of the tear film, thus inducing DED. [9] Moon et al. also reported that cessation of smartphone use for a 4-week period in children with DED resulted in significant improvements in noninvasive TBUT, punctate epithelial erosion, and OSDI scores, with all affected children no longer being classified as DED sufferers at the end of the abstinence period. ...
... Reduced blink rate and incomplete blinking are more common when focusing on a backlit screen, and this causes tear film instability, dry eyes, and visual fatigue. [20] Incomplete blinking, where the upper eyelid does not cover the entire corneal surface, can result in increased evaporation and tear film break up due to inadequate spread of the tear film and reduced tear film thickness in the inferior corneal region. This may be more pertinent to dry eye than the absolute blink rate as tear film stability can be maintained with a reduced blink rate, provided that most blinks are complete. ...
Purpose
To investigate the influence of digital device use (computers, laptops, tablets, smartphones) on dry eye disease (DED) in a pediatric population.
Settings and Design
This was a cross-sectional study. School children studying in grades 5–9 at two private schools in the city of Ahmedabad, the capital city of Gujarat, India were invited to participate in the study.
Methods
In this study, 462 children underwent ocular examination including tear film breakup time (TBUT) and Schirmer’s test. Questionnaires were administered for collecting information on the type and duration of digital device usage separately for academic and leisure activities and the Ocular Surface Disease Index (OSDI) score.
Results
The mean age of participants was 11.2 + 1.4 years, and 63% were boys. The mean OSDI score was 37.2 + 11.8, and 90.5% had symptoms of DED. Children with moderate to severe DED ( n = 88, 19%) had longer daily duration of device use and lower Schirmer’s test and TBUT values compared to children with mild DED ( P = 0.001). A cumulative exposure time of more than 3–3.5 h per day had a significantly increased risk of DED. Multivariable logistic regression analysis showed that increment in computer usage (odds ratio [OR] 1.94 for every half an hour increase, 95% confidence interval [CI] = 1.2–3.1) and children studying in higher grades (OR 1.30, 95% CI = 1.1–1.6) had a higher risk of moderate to severe dry eye.
Conclusion
Cumulative device exposure time of more than 3–3.5 h per day had a significantly increased risk of pediatric DED. Children with an increment in computer usage by half an hour per day had a higher chance of experiencing moderate to severe dry eye. Policymakers should aim to restrict the screen time below 3 h on a daily basis.
... 4 In eye care practice, a diagnosis of CVS mainly depends on subjective subject answers to different validated questionnaires, one of which is the 17-item Computer-Vision Symptom Scale questionnaire (CVSS17). 6,7 It is well known that VDT users exhibit decreased blinking frequency and amplitude, leading to an increase in ocular surface exposure, tear evaporation, and alteration of meibomian gland secretion, 8,9 which contribute to the development of dry eye symptomatology, 9 and close to 50% of VDT users suffer from dry eye disease (DED). 10 It has also been reported that contact lens (CL) wear may increase or exacerbate the presence of CVS symptoms. ...
... 4 In eye care practice, a diagnosis of CVS mainly depends on subjective subject answers to different validated questionnaires, one of which is the 17-item Computer-Vision Symptom Scale questionnaire (CVSS17). 6,7 It is well known that VDT users exhibit decreased blinking frequency and amplitude, leading to an increase in ocular surface exposure, tear evaporation, and alteration of meibomian gland secretion, 8,9 which contribute to the development of dry eye symptomatology, 9 and close to 50% of VDT users suffer from dry eye disease (DED). 10 It has also been reported that contact lens (CL) wear may increase or exacerbate the presence of CVS symptoms. ...
Objectives
To determine the prevalence of digital eye strain or computer vision syndrome (CVS) and its risk factors in a university population (University of Valladolid, Spain).
Methods
An anonymous cross-sectional online survey was conducted in a university population [staff (lecturers and administrative employees) and students (undergraduate, master's, and PhD)], including two validated questionnaires (Ocular Surface Disease Index [OSDI] and the 17-item Computer-Vision Symptom Scale questionnaire [CVSS17]) and questions about sociodemographic data and visual display terminal use. The prevalence and risk factors for CVS (CVSS17≥29) (multivariate logistic regression model) were calculated.
Results
One thousand nine participants responded to the survey (35.2±15.2 years; 64.1% women). The mean OSDI and CVSS17 questionnaire scores were 18.9±15.6 and 31.5±6.4, respectively, and 35.4% of the respondents had dry eye symptoms (OSDI>22). The total prevalence of CVS was 65.4% (95% CI 62.1–68.3). Undergraduate students showed the highest CVS prevalence (72.6%; P <0.01), which was significant. In addition, women, participants younger than 36 years old, contact lens wearers, and subjects with dry eye symptoms reported a statistically higher CVSS17 score ( P ≤0.01). In the multivariate model, significant factors associated with the presence of CVS ( P ≤0.03) were female sex (OR=2.10; 95% CI 1.54–2.88), dry eye symptoms (OSDI>22) (OR=16.98; 95% CI 10.36–27.84), VTD use ≥6 hr daily (OR=1.96; 95% CI 1.09–3.52), and being an undergraduate student (OR=2.23; 95% CI 1.54–3.24).
Conclusion
A high prevalence (65.4%) of CVS was found among the Spanish university population, with the undergraduate student group having the highest prevalence (72.6%). Female sex, more than 6 hr/day of visual display terminal use, being an undergraduate student, and dry eye symptoms significantly increased the risk of CVS in the university population.
... 96,95 The risk factors connected to DED are female sex, autoimmune disorders, ophthalmic disorders, allergy and atopy, use of contact lenses, low physical activity, or increased use of electronic devices (smartphones, tablets). [95][96][97][98][99][100][101] There are several causes of the dry eye among VDTs users, including Meibomian gland dysfunction, decreased blink rate, and ocular surface inflammation. [102][103][104] The reduced blink incidence and insufficient blinks may cause increased tear evaporation. ...
... 106 There is no consensus on the impact on lacrimal gland functioning -some works suggest that increased time of using electronic devices might lead to aqueous deficiency, while others reveal normal lacrimal functioning. 100 Another risk factor for DED -low total physical activity is inversely related to the occurrence of dry eye, an extended time of sitting or using VDTs leads to increased DED prevalence. 98 All the listed factors may disrupt the homeostatic balance of the eye, which leads to tear instability and experiencing undesirable symptoms. ...
Introduction and aim. Recently, an increased use of video display terminals has been observed in workplace environments, as a result of the evolution of communication technologies and new information-sharing strategies. It has led to an increased prevalence of computer-related ocular disorders, such as computer vision syndrome, dry eye disease, refractive errors and con vergence insufficiency. In this review we describe problems associated with these disorders and propose preventive methods. Material and methods. With the use of specific keywords, the databases of the PubMed, Science Direct, and Google Scholar were searched for relevant original papers. Analysis of the literature. The listed disorders might have similar symptoms, such as eye burning, itching, blurred vision, and tearing, and their severity correlates with the time of exposure to video display units. However, there are preventive measures, which can help in decreasing the negative effects of computers on our vision, such as adequate viewing distance, proper work space lighting, eyeglasses with anti-glare coating, taking 5-minutes breaks after every 30 minutes, or following the 20-20-20 rule. Conclusion. Prolonged usage of the video display terminals is connected to many ocular disorders, and in today’s world, it is very important to remember actions that can be undertaken to minimize the risk.
... Several studies have reported that people who used digital screens more often had a greater frequency of dry eye disease. [6][7][8][9][10][11][12][13][14] Incomplete blinking of eyes may be the major factor contributing to dry eyes, and application of lubricating eye drops may reduce symptoms of dry eyes. [15] In this study, 42.1% of the students were diagnosed with dry eyes, and more than half of them were symptomatic. ...
Purpose
To assess the proportion of dry eye among medical students in a tertiary care hospital and determine its association with digital screen exposure.
Materials and Methods
A cross-sectional study was conducted in the Ophthalmology department from October 2019 to April 2021 among 145 undergraduate medical students. Data regarding the pattern of digital screen use were collected from the students, and the symptomatology of dry eye was assessed with the help of the SPEED questionnaire. Dry eye tests were done, and data were analyzed.
Results
Mobile phone was the most frequently used screen type by the medical students (80%). Furthermore, 53.1% spent more than 1 hour using digital screens in the dark, and 59.3% of participants regularly used digital screens for 3-5 years. In addition, 68.3% used the screens at 26%–50% brightness. Results revealed that 42.1% had dry eyes, out of which 53.1% had symptomatic dry eyes, and 49.7% tested positive for dry eyes. Duration of digital screen use in the dark was the factor that was associated the most with dry eye ( P = 0.004). Increased duration of total screen use in years was found to have a significant association with dry eye among the students ( P = 0.020).
Conclusion
In this study, 42.1% of the students were diagnosed to have dry eyes. More than half of them were symptomatic. There is a significant association between digital screen exposure and dry eyes, with the longer duration of exposure and usage of screens in dim light being the key contributing factors.
... This may be attributed to prolonged exposure to UV radiation and airborne irritants (Coroneo, 2013). Dry eye syndrome affected 35.9% of participants, aligning with findings by Uchino et al. (2018) and Li et al. (2019), who reported high occupational prevalence. Other ocular issues such as glaucoma and lens opacity were also observed, consistent with prior epidemiological data (Flaxman et al., 2017;Tham et al., 2014). ...
Air pollution is a major public health concern linked to various diseases, including ocular health problems. In Nigeria, road transport workers, particularly drivers, are highly exposed to pollutants due to occupational hazards. Limited research exists on the ocular impacts of air pollution in this population. This study aimed to determine the influence of air pollutants on ocular health among road transport workers in Imo State, Nigeria, and assess awareness and preventive measures related to air pollution and ocular health. A crosssectional descriptive study was conducted in motor parks across three senatorial zones of Imo State. A total of 552 road transport workers, including drivers, conductors, and traders, were surveyed using structured questionnaires and clinical eye examinations. Data were analyzed for socio-demographics, presence of ocular problems, awareness, and use of preventive measures. The study revealed that 81.2% of the examined eyes had ocular issues. Pterygium (35.8%) and dry eye syndrome (22.2%) were the most common conditions. Awareness of air pollution's impact on ocular health was high (84.1%), but only 31% of participants used preventive measures. Those who applied preventive measures had significantly lower rates of ocular problems (51.5%) compared to those who did not (94.5%). Protective practices like wearing glasses and avoiding smoke areas were associated with reduced ocular issues. Thus, air pollution significantly affects the ocular health of road transport workers in Imo State. Increasing awareness and promoting the use of preventive measures are essential to mitigating these health impacts.
... Prolonged exposure by facing visual display terminals (VDTs) is a risk factor for dry eyes, eye fatigue, and eye inflammation. [1][2][3] Therefore, many people are at potential risk for these ocular conditions because VDTs are indispensable in modern life and work. Currently, drugs approved for the treatment of dry eye target increased mucin secretion and corneal epithelial damage. ...
Dry eye disease is an ocular disease in which the stability of tear fluid decreases, causing ocular discomfort and abnormal visual function as well as damage to the ocular surface. It has been reported that specific types of food ingredients can promote lachrymal secretion, which is expected to prevent and improve dry eye. Here, we evaluated the effects of a heat-killed form of Fructobacillus fructosus FMO-85, a species of fructophilic lactic acid bacteria (FLAB) that is derived from the digestive tract of honeybees, on lacrimal fluid secretion using a stress-induced dry eye mouse model. Male C57BL/6J mice were fed a 3% FLAB-mixed diet 3 weeks before stress loading. We observed that the tear fluid volume was decreased after stress loading, which was significantly improved by FLAB treatment after 7 and 11 days. Mechanistically, the mRNA levels of brain-derived neurotrophic factor (Bdnf), one of the important growth factors involved in lacrimal fluid secretion, isoform-2 and -6 were increased in the hippocampus of FLAB-treated mice. Furthermore, the plasma levels of an anti-inflammatory cytokine, interleukin-10 (IL-10), increased in the FLAB-treated mice. These results suggested that the ingredients contained in dried FLAB increase tear fluid volume by affecting the lacrimal secretion mechanism and the production of inhibitory cytokines. In conclusion, the decrease in tear fluid volume after stress loading was suppressed by FLAB intake. These results indicated that FLAB supplementation may be a useful strategy for the prevention and treatment of dry eye.
... In DECS-K, 94.3% of 158 patients who were diagnosed with DED in hospital settings had a TBUT ≤5 sec [20]. In the Osaka study in relatively young VDT users (n = 561), 78.6% of participants had a TBUT ≤5 sec, even in the absence of abnormal tear secretion or obvious ocular surface staining [5]. Collectively, these studies support the use of tear film instability as a diagnostic criterion for DED in clinical practice. ...
Purpose
To investigate the concordance between Asia Dry Eye Society (ADES) diagnostic criteria and real-world hospital-based practice, and to analyze the clinical characteristics of patients with dry eye disease (DED), in Taiwan.
Study Design
Noninterventional, cross-sectional, retrospective clinical study.
Methods
Data were analyzed for adults with newly diagnosed DED from three tertiary hospitals. The primary endpoint was the proportion of patients diagnosed with DED who fulfilled ADES criteria for DED. Other outcomes were DED classification and severity, tear breakup time (TBUT), Schirmer’s test, corneal fluorescein staining (CFS) severity, 12-item Ocular Surface Disease Index (OSDI) questionnaire scores, and presence of meibomian gland dysfunction (MGD).
Results
A total of 213 patients, mean (SD) age 54.3 (15.0) years, 79.8% female, were evaluated. Mean TBUT of 3.0 (2.6) sec and mean OSDI score of 36.5 (21.0) indicated severe DED at diagnosis. Most patients (87.3%) had a TBUT ≤5 sec, fulfilling ADES diagnostic criteria. Short TBUT (≤5 sec) and OSDI ≥13 had high sensitivity for diagnosing DED (87.3% and 90.1%, respectively), whereas an abnormal Schirmer’s test (69.5%) and abnormal CFS (42.3%) were less sensitive. MGD was diagnosed in 56.3% of patients. Dry eye-related characteristics in the non-short TBUT (>5 sec) group diverged for objective but not subjective clinical tests. Most common first treatments were artificial tears (95.8%) and corticosteroids (85.0%).
Conclusions
DED diagnosis in routine hospital practice in Taiwan is highly concordant (87.3%) with ADES diagnostic criteria. TBUT appears to be an effective diagnostic tool for identifying dry eye in patients across symptom severity, etiology and age.
... Therefore, the ocular insert offered a promising method for the delivery of azithromycin in the ocular chamber as treatment of eye inflammation and infections. [24] Harjeet et al. ...
... From a clinical perspective, the usage of a visual display terminal device is an important factor for DED development in modern society. More than 60 percent of visual display terminal users have DED [19]. Less blinking during the use of a computer, tablet, or cell phone can damage the ocular surface and contribute to DED development [20]. ...
Objective: The aim of this study was to evaluate the correlation between the duration of cataract surgery and the postoperative dry eye disease (DED) parameters. Methods: A retrospective cohort study was conducted on individuals who received cataract surgery at our institution. In total, 72 and 36 eyes were split into the short and long surgery groups, respectively. The main outcomes were the postoperative tear break-up time (TBUT), the Schirmer II test result, the ocular surface staining score, the DED symptoms, and the presence of meibomian gland dysfunction (MGD). A generalized linear model was employed to compare the changes in the DED parameters between the two groups. Results: The uncorrected visual acuity (UDVA) was significantly better in the short surgery group compared to the long surgery group (p = 0.031). The latter group also demonstrated a significantly shorter TBUT and a higher ocular surface stain score compared to those of the short surgery group (both p < 0.05). The change in the TBUT and ocular surface stain score were significantly higher in the long surgery group than the short surgery group (both p < 0.05). No DED parameters were significantly associated with the postoperative UDVA in the short surgery group (all p > 0.05). However, the TBUT and the ocular surface stain score correlated with worse postoperative UDVA in the long surgery group (both p < 0.05). Conclusions: Operating on a cataract for more than 20 min correlates with a long TBUT and a poor ocular surface staining score, which could influence the postoperative UDVA.
... 25 The prevalence of DED in the Asian region has been extensively studied. 19,27,28 Reports indicate rates ranging from 20.0% to 52.4% in East Asia (China, Japan, and Korea), as documented in the TFOS DEWS II epidemiological study on DED. 4 Our findings in the same region align with these results, showing a prevalence of 28.4%. However, the study also reported a lower prevalence among Asian women at 21.6%, contrasting with our research result of 28.1%. ...
Purpose
To investigate the epidemiological characteristics of dry eye disease (DED) in Asian populations and among females.
Methods
This study utilized the literature-derived database on DED risk factors, which includes data from 119 studies, and followed an evidence-based medicine retrieval strategy, searching globally for studies on risk factors for DED. Specifically, we focused on the Asian and Asian female populations. A descriptive statistical analysis was conducted on the definitions and prevalence of DED as provided in the database.
Results
The study included a total of 139,556 participants, of which 74,258 were females. The overall prevalence of DED in Asians was found to be 23.9%, and it was observed to increase with age. Specifically, the prevalence was 16.2% in the group aged <30 years, and it increased to 26.7% in the group aged over 70 years. Among females, the prevalence of DED was higher at 28.1% compared to males at 20.1%. Furthermore, the prevalence of DED in females also increased with age, ranging from 39.9% in the group aged <40 years to 42.2% in the group aged over 60 years. The prevalence of DED between 2016 and 2022 was 35.3%, which indicated a significant increase of 14.6% compared to the period between 2008 and 2015. Notably, there were variations in the prevalence of DED across different regions and levels of development.
Conclusions
This study reveals a common occurrence of DED among Asians and women. The prevalence rates vary among different countries, regions, development levels, and sample sizes, and there is an observed upward trend with the increase in survey year and age.
... With the advent of changing technology, long-term use of digital devices leading to increased screen exposure (computers, smartphones), environmental pollution, and changing lifestyles, dry eye has become a public health issue. [1] Regarding the pathogenesis of dry eye, it is postulated that the tear film becomes hyper-concentrated or hyperosmolar due to insufficient tear production or excessive tear evaporation, which disturbs the homeostasis of the tear film. [2] Aqueous deficiency and evaporative dry eye are the two main types. ...
Purpose
This study aimed to determine the effect of intense pulsed light (IPL) treatment on meibomian gland disease.
Settings and Design
This is a prospective interventional study.
Methods
Seventy eyes of patients with dry eye disease undergoing three sessions of IPL therapy, 15 days apart, were included. Each patient completed the dry eye questionnaire (SPEED) for symptomatic assessment. Dry eye evaluation tests were performed, including Schirmer’s 1 test, meiboscopy, noninvasive tear break-up time (NIBUT) and interferometry. These tests were repeated before each IPL session.
Statistical Analysis Used
Data analysis was performed using IBM SPSS Statistics software (Version 20, Inc., Chicago, Illinois, USA). To Kolmogorov–Smirnov test was used to assess the normality of the variables. The Chi-square test was applied for statistical analysis. Level of significance was set at p ≤ 0.05.
Results
The mean symptom score from the dry eye questionnaire (SPEED) showed a significant reduction of 24.5% ( p < 0.001) in symptoms. Schirmer’s 1 test showed an improvement of 16.43% on day 15 and 40.13% on day 45. Meiboscopy grade improved by 13.54% on day 45. NIBUT improved from 53.29% on day 15 to 135.53% on day 45. Interferometry showed an improvement of 58.91% on day 45.
Conclusions
The various investigative tests demonstrated both qualitative and quantitative improvements in dry eye disease, and patients reported symptomatic relief. The effects of IPL therapy, in terms of symptomatic relief, continued to improve with each session. The quality of the tear film also improved progressively. IPL therapy is a potential therapeutic option for MGD.
... Ocular motor responses to computer screens, such as accommodation and vergence, appear to be similar to viewing printed materials (Rosenfield, 2011). However, multiple studies have reported that changes in ocular surface, specifically dry eyes, is strongly associated with prolonged computer use (Uchino et al., 2008(Uchino et al., , 2013. Furthermore, reading on computer screens produced the highest disturbance to the tear film of ocular surfaces compared to other reading devices and control (Talens-Estarelles et al., 2020). ...
Purpose: Working on computers for long hours has become a regular task for millions of people around the world. This has led to the increase of eye and vision issues related to prolonged computer use, known as computer vision syndrome (CVS). A main contributor to CVS caused by dry eyes is the reduction of blinking rates. In this pilot study, an intelligent, standalone eye blinking monitoring system to promote healthier blinking behaviors for computer users was developed using components that are affordable and easily available in the market.
Methods: The developed eye blinking monitoring system used a camera to track blinking rates and operated audible, visual and tactile alarm modes to induce blinks. The hypothesis in this study is that the developed eye blinking monitoring system would increase eye blinks for a computer user. To test this hypothesis, the developed system was evaluated on 20 subjects.
Results: The eye blinking monitoring system detected blinks with high accuracy (95.9%). The observed spontaneous eye blinking rate was 43.1 ± 14.7 blinks/min (mean ± standard deviation). Eye blinking rates significantly decreased when the subjects were watching movie trailers (25.2 ± 11.9 blinks/min; Wilcoxon signed rank test; p<0.001) and reading articles (24.2 ± 12.1 blinks/min; p<0.001) on a computer. The blinking monitoring system with the alarm function turned on showed an increase in blinking rates (28.2 ± 12.1 blinks/min) compared to blinking rates without the alarm function (25.2 ± 11.9 blinks/min; p=0.09; Cohen’s effect size d=0.25) when the subjects were watching movie trailers.
Conclusions: The developed blinking monitoring system was able to detect blinking with high accuracy and induce blinking with a personalized alarm function. Further work is needed to refine the study design and evaluate the clinical impact of the system. This work is an advancement towards the development of a profound technological solution for preventing CVS.
... 6,10 Most of the consumer's eyesight is between 20.0% and 40%. 44,35,45 some studies8 reported rates as high as 68.5% and 69.0%. Digital eye syndrome is thought to be related to the short-term (acute) and long-term (change) effects of interference caused by focusing on the accommodation and vergence systems. ...
Purpose: This literature review aims to explore the potential link between Convergence insufficiency (CI) and the use of electronic devices. CI is a common binocular vision disorder characterized by difficulty in maintaining proper eye alignment during near tasks. Method: Search the literature using keywords such as “Convergence insufficiency ", "electronic devices", "smartphones", "tablets" and "computer" in electronic databases such as PubMed, Scopus and Google Scholar. The review included studies examining the relationship between CI and electronics, including experimental and observational studies. Results: These used various methods, including surveys, clinical studies, and experimental designs. Findings suggest that prolonged and excessive use of electronic devices may lead to developing or worsening CI symptoms.. Factors such as close work, decreased frequency, and perceived fatigue associated with the use of electronic devices have been implicated as potential mechanisms behind this relationship. However, the evidence remains limited and inconclusive, as some studies report conflicting results. Conclusion: Although there is some evidence of a possible link between CI and electronics, more research is needed to establish a positive relationship. The results of this literature review highlight the importance of promoting healthy lifestyles and raising awareness of the risks associated with the overuse of electronic devices, especially for people with CI. Future research should focus on investigating prevention and interventions to reduce the negative effects of electronic devices on vision health.
... Dry eye was diagnosed based on the Japanese dry eye criteria. These are different from the dry eye criteria of the Dry Eye WorkShop in Western countries [63] because short TBUT-type dry eye occurs more frequently than other types of dry eye in Japan and other Asian countries [64,65]. Therefore, a new diagnostic criterion for dry eye was developed by the Asia Dry Eye Society for Asian populations [66]. ...
Background/Objectives: Meibomian gland dysfunction (MGD)-related dry eye aggravates postoperative visual outcomes in cataracts. Diffractive trifocal intraocular lenses (IOLs) decrease contrast sensitivity (CS). Intense pulsed light (IPL) improves tear film stability and ocular surface conditions in MGD-related dry eyes. We investigated the effect of preoperative MGD-related dry eye treatment combining manual meibomian gland expression (MGX) with IPL (IPL-MGX) on visual outcomes post-cataract surgery with diffractive trifocal IOL implantation. Methods: In this single-center, prospective, and open-label study, we enrolled 67 patients (134 eyes) with MGD-related dry eye undergoing cataract surgery on both eyes. Preoperatively, IPL-MGX was performed on one eye (IPL-MGX group) but not the contralateral eye (control group). Tear break-up time, high-order aberrations, and central superficial punctate keratopathy (C-SPK) were assessed. CS and corrected distance visual acuity were analyzed. Differences between groups were analyzed at 1 week, 1 month, and 3 months postoperatively. Results: The IPL-MGX group showed greater mean tear break-up time and lower mean high-order aberration and C-SPK values after preoperative IPL treatment and postoperatively (all p < 0.01). Postoperative CS was higher in the IPL-MGX group at 1 week (all spatial frequencies) (p < 0.01 [cpd = 2.9, 4.5, 7.1, and 10.2] and p < 0.05 [cpd = 1.1 and 1.8]); 1 month [2.9–10.2 cpd] (p < 0.01); and 3 months [4.5–10.2 cpd] (p < 0.01 [cpd = 10.2] and p < 0.05 [cpd = 4.5 and 7.1]) postoperatively. Mean corrected distance visual acuity was higher in the IPL-MGX group only postoperatively (p < 0.01). Conclusions: Preoperative MGD-related dry eye treatment using IPL-MGX enhances tear film stability, ocular surface conditions, and visual outcomes, potentially improving postoperative vision quality and patient satisfaction.
... 8,12 Smartphone use, disrupted tear film stability, shorter tear break-up time (TBUT), and corneal staining are accompanied by normal Schirmer test values and oxidative stress indices in the tears and at the ocular surface. [13][14][15] Studies have reported that artificially controlled environments in buildings, vehicles, and airplanes, air pollution in urban and metropolitan areas, airborne allergens, temperature, relative humidity, and behavioral factors (exposure to smoke, medications, chemicals, etc.) are commonly associated with the risk of several systemic and ocular conditions like DED. 8,[15][16][17][18] The relevance of our research lies in the study's population, which comprises patients from major cities in Mexico. These cities share several characteristics, such as inadequately controlled air pollution, high population density, and heavy traffic indexes, 19 all environmental factors that have been associated with exacerbated DED symptomatology. ...
Background
This research aims to investigate the influence of environmental factors on the treatment efficacy of ocular lubricants in patients from urban areas with dry eye disease (DED).
Methods
A phase IV clinical trial, which included 173 patients from major cities in Mexico, was randomly assigned to use ocular lubricants four times a day for 30 days. Ocular Surface Disease Index (OSDI), noninvasive tear film break-up time (NIBUT), ocular staining, and conjunctival hyperemia (CH) among other factors like weather, and air pollution as covariates were analysed.
Results
After 30 days, OSDI score decreased by 14.8 points (p<0.001), and NIBUT increased by 2.9 seconds (p< 0.001), with longer values observed in patients recruited in autumn and winter (additional 1.8 seconds, p< 0.05) compared to those recruited in spring. Patients living in cities with cooler weather and high humidity, but low air quality had higher OSDI and conjunctival stain scores of up to 4.4 and 0.3 points, respectively, as compared to those living in cities with similar pollution and humidity levels but with higher temperatures (p-values= 0.019 and 0.050). Patients with moderate CH had an increase of up to 0.8 points in their corneal stain score (p< 0.010). We also found that ozone levels were related to the predicted changes in OSDI and NIBUT.
Conclusion
This study demonstrated the impact of environmental factors on the signs and symptoms of DED and suggests that patients residing in cities with inadequately controlled air pollution can benefit from using ocular lubricants to alleviate their symptoms.
Trial Registration
Trial is registered at clinicaltrials.gov (NCT04702776).
... 4,5 The primary clinical manifestation of CVS is dry eye disease (DED), which occurs at a prevalence of approximately 60%. 6 DED is characterized by persistent symptoms such as tearing, burning or stinging sensations, ocular discomfort, blurred vision, and photophobia. These symptoms have been documented to have negative effects on quality of life (QoL), impacting not only vision-related daily life but also broader aspects of general wellbeing. ...
... In this study, we adopted the diagnostic criteria proposed by the Japanese Dry Eye Society, where DED is objectively indicated by a Schirmer's test result of less than 6 mm or a TBUT of less than 6 seconds. 15,16 Sleep disorders, notably, are deemed significant DED risk factors, 17,18 with a hypothesized bidirectional relationship: sleep disturbances alter the ocular surface environment, including hyperosmotic tear, decreased TBUT, and decreased tear secretion, 19 exacerbating DED symptoms, which, in turn, affect sleep quality. Among sleep disorders, OSA is particularly implicated in DED, supported by multiple studies. ...
Study Objectives
To evaluate the association between obstructive sleep apnea (OSA) and dry eye disease (DED) and analyze the impact of Continuous Positive Airway Pressure (CPAP) on DED.
Methods
This is a retrospective population-based case-control study. Patients who underwent polysomnography in Taiwan from March 1, 2009, to March 1, 2020, were identified from the database of a sleep center. Patients who were diagnosed with keratoconjunctivitis sicca or tear film insufficiency were included. Patients without data from Schirmer’s test, lacking tear break-up time values, or with a history of refractive surgery, Sjögren’s syndrome, ocular injuries, or a disability in eyelid closure were excluded. All patients with DED enrolled had DED in both eyes. OSA severity between patients with and without DED was compared.
Results
In total, 86 patients with DED and 86 age-matched patients without DED were enrolled. Significant differences in apnea-hypopnea index values (patients with DED: 29.1 ± 23.4, patients without DED: 17.9 ± 20.2, P < 0.001), OSA severity (P < 0.001), and lowest oxygen saturation (P = 0.040) between patients with and without DED were observed. A multivariate logistic regression model indicated that the use of CPAP was independently associated with DED after adjustments for OSA severity. Patients undergoing CPAP were at greater risk of developing DED than those not undergoing CPAP (Odds ratio: 3.93, 95% confidence interval: 1.47–10.49, P = 0.006).
Conclusion
OSA severity is associated with DED and might be attributed to the use of CPAP.
... The incidence of dry eye increases with age due to systemic changes [111]. While medication is the primary treatment for dry eye, addressing environmental factors and adjusting daily habits are also crucial for treating and preventing the disease. ...
... 3 Moreover, DED has been correlated with psychological and sleep disorders, contributing to extensive economic, social, and psychological repercussions for affected individuals. 4 Given the evolving epidemiological landscape marked by a transition from communicable to non-communicable chronic diseases, recent studies project a substantial and continuing increase in the annual incidence andprevalence of DED. 5 Therefore, it is imperative for healthcare providers to recognize that sustainable disease control necessitates not only effective treatment but also the implementationof robust preventive strategies. As efforts persist in treating existing DED cases, it iscrucial to concurrently focus on preventive measures to mitigate the overall impact of the disease. ...
Introduction: Dry eye disease (DED) results from dysregulated ocular inflammation, causing persistent ocular surface dysfunction, with a global surge in prevalence, especially among children and adolescents, due to increased technology use. Beyond significant ocular morbidity, DED's association with systemic autoimmune disorders, impact on quality of life, and links to psychological and sleep disorders underscore its extensive repercussions. This systematic review aims to comprehensively explore an integrated approach to managing DED, emphasizing preventive and promotive strategies across various levels of healthcare. Method: The researchers in this study followed the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to ensure that their work met the required standards. This was done to ensure the precision and reliability of the conclusions derived from the research. Result: This systematic review investigated final 15 articles. After looking at the titles and summaries, we found 6 papers that fit our criteria. At first, we excluded several articles because they were written in review style and case reports. But after reading the full papers carefully, we included four papers in our final analysis. These papers included a retrospective observational study, prospective study, and double-blind, randomized, placebo-controlled trial, and prospective interventional pilot study. Conclusion: In summary, a study suggests that OPT-IPL (Optilight Intense Pulse Light) treatment enhances tear film lipid layer (TFLL) and improves signs and symptoms of dry eye disease (DED) by enhancing meibomian gland function. The phase 3 trial with NOV03 provides compelling evidence of reduced DED signs and symptoms over 8 weeks, demonstrating statistical and clinical significance, with good tolerability. Additionally, the ESSENCE-2 trial highlights the efficacy of a water-free cyclosporine solution in improving ocular surface staining associated with DED, showcasing potential advantages over existing therapies. Our study revealed promising and safe outcomes for dietary supplementation, which preserved tear production in a rat dry eye model and showed significant improvements in both objective parameters and subjective dry eye symptoms. However, further data is needed to validate its widespread use as a common intervention.
... In line with these findings, Estarelles et al. demonstrated that implementing the 20-20-20 rule was effective in reducing DED and dry eye symptoms [28] . Several studies have also emphasized the relationship between digital screen exposure and DED, advocating for measures such as limiting screen time, adjusting screen settings, and adopting ergonomic practices to alleviate symptoms [29,30,2] . Moreover, various medications including artificial tears, anti-inflammatory agents, and immunomodulators have been shown to be beneficial in managing DED [31,32] . ...
... However, while several studies have found correlations between certain diabetic parameters and the risk of developing dry eye, the underlying mechanisms responsible for this is not yet fully understood [5] . In particular, the ocular and systemic factors affecting tear stability or short tear break up type of dry eye is not known, which is important in considering that the short tear break up type of dry eye is the most common type of dry eye in Asia [6] . Regarding their demographic details, past medical history, ocular history, duration of diabetes mellitus, use of insulin and a recent HbA1c report (within one week of recruitment). ...
... DED, similarly to ovarian cancer, affects numerous people, with an annual incidence of more than five percent in men and women older than 40 years [27,47]. In specific situations, like the population using a visual display terminal frequently, the incidence of DED can reach a rate as high as 60 percent [48]. Advanced DED can not only damage the ocular surface, but can also contribute to significant visual impairment and depressive conditions [27]. ...
We aim to investigate the potential correlation between the presence of ovarian cancer and the development of dry eye disease (DED) via the usage of the Longitudinal Health Insurance Database (LHID) of Taiwan. A retrospective cohort study was executed, and patients with ovarian cancer were selected according to the diagnostic and procedure codes. One ovarian cancer patient was matched to four non-ovarian cancer participants which served as control group, and a total of 4992 and 19,968 patients constructed the ovarian cancer and control groups, respectively. The primary outcome in the current study is the development of DED according to the diagnostic and procedure codes. Cox proportional hazard regression was utilized to produce the adjusted hazard ratio (aHR) and related 95% confidence interval (CI) of DED between the two groups. There were 542 and 2502 DED events observed in the ovarian cancer group and the control group, respectively. The ovarian cancer group illustrated a significantly higher incidence of DED development than the control group after the adjustment of several confounders (aHR: 1.10, 95% CI: 1.01–1.21, p = 0.040). In the subgroup analysis stratified by age, ovarian cancer patients aged older than 60 years showed a higher incidence of DED compared to the non-ovarian cancer population (aHR: 1.19, 95% CI: 1.08–1.28, p = 0.011). In addition, ovarian cancer patients with a disease duration longer than five years also showed higher incidence of DED formation than the non-ovarian cancer population (aHR: 1.13, 95% CI: 1.04–1.22, p = 0.027). In conclusion, the presence of ovarian cancer is associated with higher incidence of subsequent DED, especially in those older than 60 years and with a disease interval of more than five years.
... In a previous Japanese clinical study, 76% of dry eye patients had a negative ocular surface staining, but 95% of them had an unstable tear film (TBUT≤5s). [7,27] Retrospective medical records of 1,691 Korean patients with dry eye showed that 47.5% of them were Level I with minimal ocular surface staining. [9] Eom et al.'s study also demonstrated that 54.4% of 158 Korean patients with dry eye were also Level I. [28] Mean TBUT values in patients with Level I were 3.2±1.5s. ...
New Korean guidelines for the diagnosis and management of dry eye disease were developed based on literature reviews by the Korean Dry Eye Guideline Establishment Committee, a previous dry eye guideline by Korean Corneal Disease Study Group, a survey of Korean Dry Eye Society (KDES) members, and KDES consensus meetings. The new definition of dry eye was also proposed by KDES regular members. The new definition by the regular members of the KDES is as follows: “Dry eye is a disease of the ocular surface characterized by tear film abnormalities and ocular symptoms.” The combination of ocular symptoms and an unstable tear film (tear breakup time <7 seconds) was considered as essential components for the diagnosis of dry eye. Schirmer test and ocular surface staining were considered adjunctive diagnostic criteria. The treatment guidelines consisted of a simplified stepwise approach according to aqueous deficiency dominant, evaporation dominant, and altered tear distribution subtypes. New Korean guidelines can be used as a simple, valid, and accessible tool for the diagnosis and management of dry eye disease in clinical practice.
Objective: This research seeks to investigate the effects of preoperative intense pulsed light with manual meibomian expression (IPL-MGX) on the refractive accuracy of cataract surgery on dry eyes with meibomian gland dysfunction (MGD-related dry eyes). Methods: Fifty-six MGD-related dry eye cases planned for cataract surgery were analyzed. IPL-MGX (four times at 2-week intervals) was performed before preoperative examination. Axial length (AL), anterior chamber depth (ACD), corneal curvature (mean-K), tear break-up time (TBUT), superficial punctate keratopathy in the central cornea (C-SPK), corneal higher-order aberrations (HOAs), and predicted postoperative spherical equivalent (P-SE) were evaluated pre- and post-IPL-MGX. The postoperative subjective spherical equivalent (S-SE) was evaluated after one month. The absolute difference between the S-SE and P-SE was considered an indication of P-SE accuracy. Changes in all the variables were assessed before and after IPL-MGX treatment. Results: No significant differences were observed in AL or ACD (p = 0.85, 0.56). The differences in mean-K, TBUT, C-SPK, and HOAs were significant (p < 0.01). P-SE accuracy based on post-IPL-MGX data was significantly higher than that based on pre-IPL-MGX data (p < 0.01). P-SE accuracy was within 0.25 diopters (D) in 14.3% of pre- and 55.4% of post-IPL-MGX, within 0.5D in 55.4% of pre- and 92.9% of post-IPL-MGX, within 0.75D in 98.2% of pre- and post-IPL-MGX, and within 1.0D in 98.2% of pre- and 100% of post-IPL-MGX. In the range of 0.25 and 0.5 D, the accuracy of P-SE was significantly higher in post-IPL-MGX (p < 0.01). Conclusions: Preoperative IPL-MGX considerably improved the predicted postoperative refraction accuracy in patients with MGD-related dry eye undergoing cataract surgery.
With the increase of virtual reality (VR) applications in daily life, protecting the comfort and health of VR users has become increasingly important. The immersive nature of VR often results in decreased eye blinking and movement, putting users at risk of developing conditions such as dry eye syndrome and eye strain. In this article, we propose visual interfaces to induce temporary eye blinks or movements by drawing users' attention temporarily in order to mitigate the negative effects of VR on eye health. Our proposed interfaces can induce eye blinking and movement, which are known to mitigate eye problems in VR. The experimental results confirmed that our interfaces increase the frequency of eye blinking and movement in VR users.
Purpose
Conjunctival-resident γδT cells, the predominant ocular source of interleukin-17A (IL-17A), play crucial roles in dry eye disease (DED) pathogenesis. The upstream regulators of these cells are unknown. This study evaluated the role of conjunctival IL-23 expression in mediating γδT cell generation and elucidated its contribution to dry eye inflammatory responses.
Methods
Single-cell RNA sequencing (scRNA-seq) was used to identify and quantify conjunctival mRNA molecules in γδT cells in mice. The IL-23 level increased in wild-type (WT) and decreased in γδT-deficient (TCRδ–/–) mice after dry eye was induced via an intelligently controlled environmental system (ICES). Flow cytometry and transcriptome sequencing were used to investigate the impact of the changes in IL-23 expression on human γδT cells.
Results
The expression of the IL-23 receptor (IL-23R) was greater in γδT cells than in other conjunctival cell types, such as CD4+ T cells, CD8+ T cells and epithelial cells. An increase in IL-23 led to an increase in γδT cell density, which was proportional to dry eye severity. However, in the TCRδ–/– mice, the upregulation of IL-23 failed to increase the expression level of IL-17A and the severity of dry eye. Furthermore, increases in the expression of IL-23 and the number of γδT cells were evident in the ocular surface cells of patients who developed visual display terminal syndrome.
Conclusions
An increase in conjunctival IL-23 expression contributes to the induction of the DED inflammatory response through interactions with its cognate receptor on γδT cells and the promotion of their proliferation. The findings of this study suggest that the suppression of IL-17A through the blockade of IL-23R activation may be a viable target for improving the management of inflammation in DED patients.
Background
The 2017 TFOS DEWS II report provided an overview of the epidemiology of dry eye disease (DED) and identified several potential risk factors. This study aimed to conduct a meta-analysis on these potential risk factors.
Methods
A comprehensive systematic search was conducted in PubMed, Embase, Web of Science, and Cochrane Library databases to include observational studies. Two researchers independently extracted adjusted odds ratios (AORs) and their 95% confidence intervals (CIs), and a random-effects model was used to combine the data. Results were reported using odds ratios (ORs) and their 95% CIs.
Results
The meta-analysis results showed that the risk factors for DED were smoking (OR 1.18, 95% CI 1.07–1.29), alcohol consumption (OR 1.18, 95% CI 1.03–1.35), rosacea or acne (OR 1.96, 95% CI 1.56–2.45), allergic conjunctivitis (OR 4.59, 95% CI 3.38–6.23), refractive surgery (OR 1.78, 95% CI 1.05–3.00), diabetes (OR 1.14, 95% CI 1.06–1.22), thyroid disease (OR 1.57, 95% CI 1.36–1.82), viral infections (OR 1.54, 95% CI 1.33–1.78), anxiety (OR 2.39, 95% CI 1.30–4.39), depression (OR 1.59, 95% CI 1.39–1.82), post-traumatic stress disorder (OR 1.43, 95% CI 1.42–1.45), and stress (OR 1.59, 95% CI 1.24–2.05). However, there was no significant association between Hispanic ethnicity, menopause, past smoking, current smoking, multivitamin use, and DED.
Conclusion
These findings provide valuable insights for further research on the prevention and treatment of dry eye disease.
Topical instillation of cyclosporin A (an anti‐inflammatory drug) is clinically recommended as the first‐line treatment for dry eye disease. Nevertheless, it suffers from poor ocular drug retention and cannot comprehensively address corneal dryness‐related symptoms such as oxidative stress, angiogenesis, and neurodegeneration. Inspired by nanotechnology‐mediated material/biological interactions, in this study, a highly adhesive metallic nanoplatform with an urchin‐like structure is designed for topical quercetin administration in dry eye therapy. The gold nanostructures with the most pronounced branch lengths exhibit the strongest cytoadhesion and bioadhesion capabilities, which significantly enhance the corneal retention of nano‐urchins by 150‐fold at 7 days post‐instillation compared with smooth‐surfaced gold nanoparticles. In a rabbit model of corneal dryness, topical single‐dose nanoformulation (high quercetin‐functionalized gold nano‐urchins (NU‐Q(H))) demonstrated remarkable efficacy in stimulating tear production (30‐fold improvement), inhibiting inflammatory IL‐6 expression (49‐fold improvement), attenuating pathological angiogenesis (32‐fold improvement), and promoting nerve regeneration (18‐fold improvement) compared to high quercetin‐functionalized gold nanoparticles (NP‐Q(H)). In particular, the integrity of the ocular surface, tear film, and meibomian gland is restored to levels similar to those in healthy rabbits. These findings suggest the promising potential of nanobiomaterial structural engineering in developing highly adhesive metallic nanomedicines as long‐acting eye‐drop formulations for disease treatment applications.
After developing job-exposure matrices (JEMs) for screen and sedentary time, we aimed to assess the associations between the JEM-derived exposures and various ocular diseases. We collected data from patients hospitalized from 2005 to 2021. JEMs were developed from 41,718 patients with occupational information and screen and sedentary times. The adjusted means of screen and sedentary time were calculated for 143 occupational groups and categorized into three classes based on the tertiles. The associations between ocular diseases and these JEM-derived exposures were examined using multivariable conditional logistic regression for 727,589 patients. The odds ratios of the class with highest screen time were 1.05 (95% confidence interval, 1.01–1.09) for cataract, 1.24 (1.06–1.45) for primary open-angle glaucoma (POAG), 1.26 (1.06–1.49) for rhegmatogenous retinal detachment (RRD), 1.49 (1.26–1.76) for ptosis, and 0.39 (0.27–0.57) for pterygium. The odds ratios of the class with highest sedentary time were 1.05 (1.01–1.09) for cataract, 1.24 (1.05–1.46) for RRD, 1.68 (1.42–1.99) for ptosis, and 0.60 (0.42–0.84) for pterygium. Both screen and sedentary time were positively associated with cataract, RRD and ptosis. Interestingly, POAG had a positive association with only screen time. Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary."I have confirmed that the content is correct. No amendments are necessary.Please check article title if captured correctly."?>"I have confirmed that the content is correct. No amendments are necessary.
В статье представлен аналитический обзор литературы о проблеме диагностики и лечения болезни сухого глаза и ассоциированного с ней кератита (БСГ). Ключевым звеном патогенеза данного заболевания является хроническое воспаление глазной поверхности. Местное применение глазных капель, содержащих циклоспорин А, позволяет значительно улучшить результаты лечения этой тяжелой патологии и снизить риск осложнений.
The analytical review of the literature on the problem of diagnosis and treatment of dry eye disease and associated keratitis (DED) is presented in the article. The key point of the pathogenesis of this disease is a chronic inflammation of the ocular surface. Local use of the cyclosporine A eye drops can significantly improve the results of treatment of this severe pathology and reduce the risk of complications. Keywords: dry eye disease, cyclosporine, keratitis
Dry eye syndrome (DES) is a tear film disorder caused by increased tear evaporation or decreased production. The heavy workload on the eye and the increased usage of digital screens may decrease blink frequency, leading to an increased evaporation rate and an upsurge in the incidence and severity of DES. This study aims to assess the severity of DES symptoms and the risk factors among university students. A cross-sectional study was conducted at Umm AlQura University to evaluate the severity of DES among students and explore its potential association with digital screen use. Validated questionnaires were used to assess the severity of DES and digital screen usage. The study included 457 participants, of which 13% had symptoms suggestive of severe DES. Furthermore, multiple risk factors had a significant association with the severity of DES, including gender, use of monitor filters, monitor and room brightness, and smoking habits. DES symptoms were prevalent among university students, particularly female students. Although there was no significant association with the duration of screen usage and collage distribution. Other factors however, such as the usage of screen monitors and the brightness of both the monitor and the room, were significantly associated with the severity of DES symptoms.
Importance
Taking ω-3 supplements has been associated with a reduction in symptoms of dry eye disease (DED) associated with meibomian gland dysfunction (MGD). However, a recent relatively large clinical trial concluded that treating DED with ω-3 consumption was ineffective, potentially warranting additional investigations.
Objectives
To investigate the effect of re-esterified triglyceride (rTG) ω-3 fatty acid supplementation on DED associated with MGD.
Design, Setting, and Participants
This double-masked, parallel-group, randomized clinical trial was conducted at 7 institutions from September 2020 to January 2023. Patients with DED associated with MGD were included and randomly assigned to the ω-3 group (received 1680 mg of eicosapentaenoic acid and 560 mg of docosahexaenoic acid), whereas those in the grape-seed group received 3000 mg of grape-seed oil daily.
Interventions
rTG ω-3 Fatty acid supplementation vs grape-seed oil.
Main Outcome Measures
The primary end point was the Ocular Surface Disease Index (OSDI) from baseline to 6 and 12 weeks. The safety parameters were visual acuity and intraocular pressure change.
Results
A total of 132 patients (mean [SD] age, 50.6 [13.8] years; 103 female [78.0%]) were included in this study. The mean (SD) baseline OSDI scores of the ω-3 and grape-seed groups were 43.5 (16.5) and 44.1 (16.6), respectively. A total of 58 patients (87.9%) and 57 patients (86.4%) in the ω-3 and grape-seed groups, respectively, completed 12 weeks of follow-up. There were no differences in compliance with the dietary supplement intake between groups (ω-3, 95.8% and grape-seed, 95.4%). The OSDI (SD) change from baseline to 6 and 12 weeks was −20.5 (16.0) and −22.7 (15.7), respectively, in the ω-3 group and −15.1 (20.2) and −18.8 (21.7), respectively, in the grape-seed control group (difference at 6 weeks = −5.4; 95% CI, −12.15 to 1.33; P = .12 and at 12 weeks = −3.9; 95% CI, −10.90 to 3.13; P = .28). There were no changes in safety parameters or adverse events related to taking the dietary supplement in either group.
Conclusions and Relevance
This randomized clinical trial did not show a benefit of the rTG form of ω-3 for ameliorating symptoms of DED associated with MGD, although fewer than 60 participants were evaluated in each group. Any secondary outcomes from this study should be considered for hypothesis generation of future evaluations of the effect of the rTG form of ω-3 on DED associated with MGD.
Trial Registration
CRIS Identifier: KCT0004927
Objective
To evaluate the prevalence of dry eye disease (DED) in laser-assisted in situ keratomileusis (LASIK) candidates.
Methods
A chart review of consecutive LASIK candidates who underwent full ocular surface work-up was performed, including ocular surface disease index (OSDI), noninvasive tests (noninvasive tear breakup time [ni-TBUT], tear meniscus height, lipid layer thickness, and meibography), and invasive tests (Schirmer test I, fluorescein TBUT, corneal staining, and meibomian gland [MG] expressibility). The prevalence of DED was calculated according to the Dry Eye Workshop II (DEWS II), and Japanese and Asia Dry Eye Society (JDES/ADES) criteria.
Results
In total, 135 patients (270 eyes) were evaluated. The mean age was 32.6±8.3 years, and 62.9% were women (n=85); 19 patients (15.4%) wore contact lenses, and 31 patients (23.8%) used artificial tears. The mean OSDI was 18.2±16.9, which was abnormal in 54.1% (n=62). Inferior lid MG dropout was the sign with the highest percentage of abnormal results (61.5%; n=83). There were no differences between men and women in any test except for ni-TBUT (6.3±0.3 and 7.2±0.2, respectively; P =0.002). Dry eye disease prevalence was 25.9% and 53.3%, according to JDES/ADES and DEWS II criteria, respectively. The only significant risk factor for DED was artificial tear use for both DEWS II (odds ratio [OR]=3.5, confidence interval [CI] [1.35–9.39]) and JDES/ADES (OR=2.58, CI [1.03–6.48]).
Conclusions
This study found a high prevalence of DED and abnormalities in LASIK candidates and highlights the importance of ocular surface evaluation before photorefractive surgery.
This study aimed to evaluate the potential association between coronary heart disease (CHD) severity and the subsequent dry eye disease (DED) with a different severity through the use of the National Health Insurance Research Database (NHIRD) of Taiwan. A retrospective cohort study was conducted. The CHD population was further divided into a severe CHD that had received coronary artery bypass graft (CABG) surgery group and a mild CHD that had received medicine group, then matched with a 1:2 ratio, and 29,852 and 14,926 CHD patients were put into the severe CHD and mild CHD groups, respectively. The primary outcomes were the development of DED and severe DED after CHD diagnosis. The Cox proportional hazards regression was used to produce the adjusted hazard ratio (aHR) and 95% confidence interval (CI) of DED and severe DED between groups. There were 3440 and 1276 DED cases in the mild CHD and severe CHD groups, respectively. And another 37 and 48 severe CHD events were observed in the mild and severe CHD groups, respectively. The incidence of severe DED in the severe CHD group was significantly higher compared to the mild CHD group (aHR: 5.454, 95% CI: 1.551–7.180, p = 0.0001). The cumulative probabilities of DED and severe DED were significantly higher in the severe CHD group than the mild CHD group (both p < 0.0001). In the subgroup analysis, the correlation between severe CHD and DED was higher in the patients aged older than 70 years (p < 0.0001). In conclusion, severe CHD is associated with a higher incidence of severe DED with a higher cumulative incidence.
Purpose:
To evaluate the relationship between signs and symptoms of dry eye disease (DED) in a clinic-based population.
Methods:
In a retrospective analysis, clinical signs and symptoms were evaluated for 344 subjects (n = 82, normal; n = 263, dry eye), across 11 sites from the EU and United States. Pearson correlations between signs and symptoms (r(2) ) and an independent components analysis (ICA) mixing matrix were derived from the data set. Similar analysis was performed on an independent data set from 200 subjects in a previous study in Munich, Germany.
Results:
No correlations above r(2) = 0.17 were found between any signs and symptoms, except for corneal and conjunctival staining, which reported an r(2) = 0.36. In the multisite study, the average r(2) for osmolarity (0.07), tear breakup time (0.12), Schirmer test (0.09), corneal (0.16) and conjunctival staining (0.17), meibomian grading (0.11) and Ocular Surface Disease Index(®) (0.11) were consistently low. Among patients who showed evidence of DED by consensus of clinical signs, only 57% reported symptoms consistent with a diagnosis of DED. Similar results were observed in the Munich-based study data set. Each component of the ICA mixing matrix exhibited minimal residual information.
Conclusions:
No consistent relationship was found between common signs and symptoms of DED. Each type of measurement provides distinct information about the condition of the ocular surface. These results also demonstrate that symptoms alone are insufficient for the diagnosis and management of DED and argue for a consensus of clinical signs that better reflect all aspects of the disease.
The purpose of this study was to evaluate the impact of dry eye on work productivity of office workers, especially in terms of presenteeism.
A total of 396 individuals aged ≥20 years (258 men and 138 women, mean age 43.4 ± 13.0 years) were recruited through an online survey. Data from 355 responders who did not have missing values were included in the analysis. They were classified into the following four groups according to the diagnostic status and subjective symptoms of dry eye: a definite dry eye group; a marginal dry eye group; a self-reported dry eye group; and a control group. The impact of dry eye on work productivity was evaluated using the Japanese version of the Work Limitations Questionnaire. The cost of work productivity loss associated with dry eye and the economic benefits of providing treatment for dry eye were also assessed.
The degree of work performance loss was 5.65% in the definite dry eye group, 4.37% in the marginal dry eye group, 6.06% in the self-reported dry eye group, and 4.27% in the control group. Productivity in the self-reported dry eye group was significantly lower than that in the control group (P < 0.05). The annual cost of work productivity loss associated with dry eye was estimated to be USD 741 per person.
Dry eye impairs work performance among office workers, which may lead to a substantial loss to industry. Management of symptoms of dry eye by providing treatment may contribute to improvement in work productivity.
Oxidative damage and inflammation are proposed to be involved in an age-related functional decline of exocrine glands. However, the molecular mechanism of how oxidative stress affects the secretory function of exocrine glands is unclear. We developed a novel mev-1 conditional transgenic mouse model (Tet-mev-1) using a modified tetracycline system (Tet-On/Off system). This mouse model demonstrated decreased tear production with morphological changes including leukocytic infiltration and fibrosis. We found that the mev-1 gene encodes Cyt-1, which is the cytochrome b(560) large subunit of succinate-ubiquinone oxidoreductase in complex II of mitochondria (homologous to succinate dehydrogenase C subunit (SDHC) in humans). The mev-1 gene induced excessive oxidative stress associated with ocular surface epithelial damage and a decrease in protein and aqueous secretory function. This new model provides evidence that mitochondrial oxidative damage in the lacrimal gland induces lacrimal dysfunction resulting in dry eye disease. Tear volume in Tet-mev-1 mice was lower than in wild type mice and histopathological analyses showed the hallmarks of lacrimal gland inflammation by intense mononuclear leukocytic infiltration and fibrosis in the lacrimal gland of Tet-mev-1 mice. These findings strongly suggest that oxidative stress can be a causative factor for the development of dry eye disease.
To describe epidemiologic characteristics of asymptomatic and symptomatic meibomian gland dysfunction (MGD) in a general adult population in northwestern Spain.
A total of 1155 subjects aged 40 years and older were selected by an age-stratified random sample procedure in O Salnés, Spain. A standardized symptoms questionnaire was administered and a comprehensive ophthalmic evaluation, which included ocular surface tests, was carried out. Absent, viscous, or waxy white secretion upon digital expression, lid margin telangiectasia or plugging of the meibomian gland orifices was considered evidence of MGD. The prevalence and associations of asymptomatic and symptomatic MGD, and their effects on the ocular surface, were investigated.
From 937 eligible subjects, 619 (66.1%) participated (mean age [SD], 63.4 [14.5] years; range, 40-96; 37.0% males). The prevalence of asymptomatic MGD was 21.9% (95% confidence interval [CI], 18.8-25.3). This prevalence increased with age (P = 0.000) and was higher in males than in females (P = 0.003). The prevalence of symptomatic MGD was 8.6% (95% CI, 6.7-10.9). This prevalence also increased with age (P = 0.000) but was not associated with sex. Abnormal tear breakup time and fluorescein staining prevalence estimates were higher among asymptomatic subjects. After controlling for age and sex, asymptomatic MGD was associated with diabetes (adjusted odds ratio [OR(a)] 2.23) and cardiovascular disease (OR(a) 1.80), and symptomatic MGD with rosacea (OR(a) 3.50) and rheumatoid arthritis (OR(a) 16.50).
Asymptomatic MGD is more common than symptomatic MGD. Symptomatology is not associated with secondary damage to the ocular surface. Some systemic diseases may lower whereas others may raise the risk of developing symptoms. Symptom-based approaches do not seem appropriate for MGD estimation.
Dry eye has shown a marked increase due to visual display terminal (VDT) use. It remains unclear whether reduced blinking while focusing can have a direct deleterious impact on the lacrimal gland function. To address this issue that potentially affects the life quality, we conducted a large-scale epidemiological study of VDT users and an animal study.
Cross sectional survey carried out in Japan. A total of 1025 office workers who use VDT were enrolled. The association between VDT work duration and changes in tear film status, precorneal tear stability, lipid layer status and tear secretion were analyzed. For the animal model study, the rat VDT user model, placing rats onto a balance swing in combination with exposure to an evaporative environment was used to analyze lacrimal gland function. There was no positive relationship between VDT working duration and change in tear film stability and lipid layer status. The odds ratio for decrease in Schirmer score, index of tear secretion, were significantly increased with VDT working year (P = 0.012) and time (P = 0.005). The rat VDT user model, showed chronic reduction of tear secretion and was accompanied by an impairment of the lacrimal gland function and morphology. This dysfunction was recovered when rats were moved to resting conditions without the swing.
These data suggest that lacrimal gland hypofunction is associated with VDT use and may be a critical mechanism for VDT-associated dry eye. We believe this to be the first mechanistic link to the pathogenesis of dry eye in office workers.
To estimate the prevalence and risk factors for dry eye disease (DED) among US men.
Cross-sectional prevalence survey among male participants 50 years and older in the Physicians' Health Studies I (N = 18,596) and II (N = 6848). We defined DED as the presence of clinically diagnosed dry eye or severe symptoms (both dryness and irritation constantly or often). We calculated the age-standardized prevalence of DED adjusted to the age distribution of US men in 2004 and projected estimates forward to 2030. We compared DED prevalence with a similar cohort of women and examined associations with possible risk factors.
The prevalence of DED increased with age, from 3.90% among men aged 50 to 54 years to 7.67% among men 80 years and older (P for trend <.001). High blood pressure (odds ratio, 1.28; 95% confidence interval, 1.12-1.45) and benign prostatic hyperplasia (odds ratio, 1.26; 95% confidence interval, 1.09-1.44) were associated with a higher risk of DED. Use of antidepressants, antihypertensives, and medications to treat benign prostatic hyperplasia were also associated with increased risk of DED. The age-standardized prevalence of DED was 4.34%, or 1.68 million men 50 years and older, and is expected to affect more than 2.79 million US men by 2030.
Dry eye disease is prevalent and increases with age, hypertension, benign prostatic hyperplasia, and antidepressant use.
In recent years attention has been paid to meibomian gland dysfunction (MGD) as a distinct clinical entity responsible for chronic symptoms and signs and occurring independently or in association with atopy, cicatrising mucosal disorders and rosacea. Attempts to correlate MGD with microbiological and lipid biochemical changes are confounded by the absence of a clear descriptive language for the disorder and its associated changes. Such a language is crucial for the conduct of cross-sectional and natural history studies and therapeutic clinical trials. We present a comprehensive classification and grading scheme of meibomian gland disease, supporting our observations with illustrations.
To determine the causes of blindness and visual impairment in a population-based sample of older Americans.
A random sample of 3821 residents of Salisbury, Md, between the ages of 65 and 84 years was identified from Medicare records. Sixty-six percent (2520 persons) agreed to undergo an eye examination; 26% of the participants were African American. The clinical examination included acuity testing with an Early Treatment Diabetic Retinopathy Study chart and standardized refraction testing for those with a visual acuity worse than 20/30, slitlamp and dilated retinal examination by an ophthalmologist, tonometry, lens and fundus photography, and a suprathreshold visual field test. Visual impairment was defined as a best-corrected acuity in the better-seeing eye worse than 20/40 and better than 20/200, while blindness was acuity in the better-seeing eye of 20/200 or worse. For those with a visual acuity worse than 20/40 in either eye, one or more causes were assigned by an ophthalmologist and a final cause for each eye was confirmed by a panel of 3 subspecialty ophthalmologists (O.D.S., H.A.Q., and S.B.B.) based on all available evidence.
Bilateral presenting acuity worse than 20/40 increased from 4% in the 65- to 74-year age group to 16% in the 80- to 84-year age group. One third of those with presenting acuity worse than 20/40 improved to 20/40 or better with refraction. Overall, 4.5% had a best-corrected acuity worse than 20/40. African Americans were more likely to remain visually impaired than were whites despite refraction (odds ratio [95% confidence interval], 1.7 [1.1-2.6]). Whites were most often impaired or blind from age-related macular degeneration (1.2% vs 0.5%; P=.09). African Americans had higher rates of impairment and blindness from cataract or posterior capsular opacification (2.7% vs 1.1%; P=.006), glaucoma (0.9% vs 0.1%; P=.006), and diabetic retinopathy (1.2% vs 0.2%; P=. 004).
More than half of those with visual impairment or blindness had conditions that were either surgically treatable or potentially preventable. African Americans had a disproportionate number of blinding diseases, particularly those amenable to eye care intervention. Targeted interventions for specific populations to increase appropriate eye care use would greatly improve vision and function in older Americans. Arch Ophthalmol. 2000;118:819-825
Dry eye syndrome (DES) is believed to be one of the most common ocular problems in the United States (US), particularly among older women. However, there are few studies describing the magnitude of the problem in women and how this may vary with demographic characteristics.
Cross-sectional prevalence survey.
Study population: we surveyed 39,876 US women participating in the Women's Health Study about a history of diagnosed DES and dry eye symptoms. Main outcome measure: we defined DES as the presence of clinically diagnosed DES or severe symptoms (both dryness and irritation constantly or often). We calculated the age-specific prevalence of DES and adjusted the overall prevalence to the age distribution of women in the US population. We used logistic regression to examine associations between DES and other demographic factors.
The prevalence of DES increased with age, from 5.7% among women < 50 years old to 9.8% among women aged > or = 75 years old. The age-adjusted prevalence of DES was 7.8%, or 3.23 million women aged > or = 50 in the US. Compared with Whites, Hispanic (odds ratio [OR] = 1.81, confidence interval [CI] = 1.18-2.80) and Asian (OR = 1.77, CI = 1.17-2.69) women were more likely to report severe symptoms, but not clinically diagnosed DES. There were no significant differences by income (P([trend]) =.78), but more educated women were less likely to have DES (P([trend]) =.03). Women from the South had the highest prevalence of DES, though the magnitude of geographic differences was modest.
Dry eye syndrome leading to a clinical diagnosis or severe symptoms is prevalent, affecting over 3.2 million American women middle-aged and older. Although the condition is more prevalent among older women, it also affects many women in their 40s and 50s. Further research is needed to better understand DES and its impact on public health and quality of life.
The members of the Management and Therapy Subcommittee assessed current dry eye therapies. Each member wrote a succinct evidence-based review on an assigned aspect of the topic, and the final report was written after review by and with consensus of all subcommittee members and the entire Dry Eye WorkShop membership. In addition to Its own review of the literature, the Subcommittee reviewed the Dry Eye Preferred Practice Patterns of the American Academy of Ophthalmology and the International Task Force (ITF) Delphi Panel on Dry Eye. The Subcommittee favored the approach taken by the ITF, whose recommended treatments were based on level of disease severity. The recommendations of the Subcommittee are based on a modification of the ITF severity grading scheme, and suggested treatments were chosen from a menu of therapies for which evidence of therapeutic effect had been presented.
Objective
To determine the causes of blindness and visual impairment in a population-based sample of older Americans.Methods
A random sample of 3821 residents of Salisbury, Md, between the ages of 65 and 84 years was identified from Medicare records. Sixty-six percent (2520 persons) agreed to undergo an eye examination; 26% of the participants were African American. The clinical examination included acuity testing with an Early Treatment Diabetic Retinopathy Study chart and standardized refraction testing for those with a visual acuity worse than 20/30, slitlamp and dilated retinal examination by an ophthalmologist, tonometry, lens and fundus photography, and a suprathreshold visual field test. Visual impairment was defined as a best-corrected acuity in the better-seeing eye worse than 20/40 and better than 20/200, while blindness was acuity in the better-seeing eye of 20/200 or worse. For those with a visual acuity worse than 20/40 in either eye, one or more causes were assigned by an ophthalmologist and a final cause for each eye was confirmed by a panel of 3 subspecialty ophthalmologists (O.D.S., H.A.Q., and S.B.B.) based on all available evidence.Results
Bilateral presenting acuity worse than 20/40 increased from 4% in the 65- to 74-year age group to 16% in the 80- to 84-year age group. One third of those with presenting acuity worse than 20/40 improved to 20/40 or better with refraction. Overall, 4.5% had a best-corrected acuity worse than 20/40. African Americans were more likely to remain visually impaired than were whites despite refraction (odds ratio [95% confidence interval], 1.7 [1.1-2.6]). Whites were most often impaired or blind from age-related macular degeneration (1.2% vs 0.5%; P=.09). African Americans had higher rates of impairment and blindness from cataract or posterior capsular opacification (2.7% vs 1.1%; P=.006), glaucoma (0.9% vs 0.1%; P=.006), and diabetic retinopathy (1.2% vs 0.2%; P=.004).Conclusions
More than half of those with visual impairment or blindness had conditions that were either surgically treatable or potentially preventable. African Americans had a disproportionate number of blinding diseases, particularly those amenable to eye care intervention. Targeted interventions for specific populations to increase appropriate eye care use would greatly improve vision and function in older Americans.
Objective
To examine risk factors for the prevalence of dry eye syndrome in a population-based cohort.Methods
The prevalence of dry eye was determined by history at the second examination (1993-1995) of the Beaver Dam Eye Study cohort (N = 3722).Results
The cohort was aged 48 to 91 years (mean ± SD, 65 ± 10 years) and 43% male. The overall prevalence of dry eye was 14.4%. Prevalence varied from 8.4% in subjects younger than 60 years to 19.0% in those older than 80 years (P<.001 for test of trend). Age-adjusted prevalence in men was 11.4% compared with 16.7% in women (P<.001). After controlling for age and sex, the following factors were independently and significantly associated with dry eye in a logistic model: history of arthritis (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.56-2.33), smoking status (past, OR, 1.22; 95% CI, 0.97-1.52; current, OR, 1.82; 95% CI, 1.36-2.46), caffeine use (OR, 0.75; 95% CI, 0.61-0.91), history of thyroid disease (OR, 1.41; 95% CI, 1.09-1.84), history of gout (OR, 1.42; 95% CI, 1.02-1.96), total to high-density lipoprotein cholesterol ratio (OR, for 1 unit, 0.93; 95% CI, 0.88-0.99), diabetes (OR, 1.38; 95% CI, 1.03-1.86), and multivitamin use (past, OR, 1.35; 95% CI, 1.01-1.81; current, OR, 1.41; 95% CI, 1.09-1.82). Nonsignificant variables included body mass; blood pressure; white blood cell count; hematocrit; history of osteoporosis, stroke, or cardiovascular disease; history of allergies; use of antihistamines, parasympathetics, antidepressants, diuretics, antiemetics, or other drying drugs; alcohol consumption; time spent outdoors; maculopathy; central cataract; and lens surgery.Conclusion
The results suggest several factors, such as smoking, caffeine use, and multivitamin use, could be studied for preventive or therapeutic efficacy.
The aim of the DEWs Definition and Classification Subcommittee was to provide a contemporary definition of dry eye disease, supported within a comprehensive classification framework. A new definition of dry eye was developed to reflect current understanding of the disease, and the committee recommended a three-part classification system. The first part is etiopathogenic and illustrates the multiple causes of dry eye. The second is mechanistic and shows how each cause of dry eye may act through a common pathway. It is stressed that any form of dry eye can interact with and exacerbate other forms of dry eye, as part of a vicious circle. Finally, a scheme is presented, based on the severity of the dry eye disease, which is expected to provide a rational basis for therapy. these guidelines are not intended to override the clinical assessment and judgment of an expert clinician in individual cases, but they should prove helpful in the conduct of clinical practice and research.
To evaluate the efficacy of commonly used biomarkers in dry eye disease management in a longitudinal observational case series study followed by an interventional study in a subset of subjects treated with cyclosporine A (0.05%).
Bilateral tear osmolarity, Schirmer, tear film breakup time (TBUT), staining, meibomian grading, and Ocular Surface Disease Index were measured for a period of 3 consecutive months in participants recruited from a clinic-based population at 2 study sites. Fifty-two subjects completed the study (n = 16 mild/moderate, n = 36 severe; age, 47.1 ± 16.1 years). After the 3-month observation period, severe dry eye patients were prescribed topical cyclosporine A and evaluated for an additional 3 months.
Tear osmolarity (8.7 ± 6.3%) exhibited significantly less variability over a 3-month period than corneal staining (12.2 ± 8.8%, P = 0.040), conjunctival staining (14.8 ± 8.9%, P = 0.002), and meibomian grading (14.3 ± 8.8%, P < 0.0001) across the entire patient population. Osmolarity also demonstrated less variation than TBUT (11.7 ± 9.0%, P = 0.059), Schirmer tests (10.7 ± 9.2%, P = 0.67), and Ocular Surface Disease Index (9.3 ± 7.8%, P = 0.94), although the differences were not significant. Variation in osmolarity was less for mild dry eye patients (5.9 ± 3.1%) than severe dry eye patients (10.0 ± 6.9%, P = 0.038). After treatment, average osmolarity and variability were lowered from 341 ± 18 mOsm/L to 307 ± 8 mOsm/L (P < 0.0001, n = 10). A downward trend in symptoms followed changes in osmolarity, declining from 44 ± 17 mOsm/L to 38 ± 18 mOsm/L (P = 0.35). None of the other signs demonstrated a change after treatment.
Over a 3-month period, tear film osmolarity was found to have the lowest variability among commonly used signs of dry eye disease. Reductions in osmolarity preceded changes in symptoms during therapy.
To investigate dry eye disease (DED) and risk factors in patients with depressive or anxiety disorders at a psychiatric clinic in China.
Cross-sectional study. Subjects (≥16 years) who had depressive or anxiety disorders were evaluated with history, questionnaires (Self-rating Anxiety Scale, Self-rating Depression Scale, and Ocular Surface Disease Index), and eye examination.
There were 472 psychiatric patients in the study, including 176 patients (37%) with depression, 170 patients (36%) with generalized anxiety disorder, 60 patients (13%) with depression and anxiety disorder, 55 patients (12%) with obsessive-compulsive disorder, and 11 patients (2%) with panic disorder. DED was present in 283 patients (60%). Compared with patients who did not have DED, patients with DED were significantly older, had longer duration of psychiatric disease and use of antianxiety or antidepressant medication, and more frequently were using a selective serotonin reuptake inhibitor (SSRI). Logistic regression analysis showed that older age, duration of psychiatric disorder, and use of an SSRI were significant independent predictors of the presence of DED. Older age, Self-rating Anxiety Scale >52, and use of tricyclic antidepressants were significant independent predictors of worse vision-targeted health-related quality of life (higher Ocular Surface Disease Index).
DED is frequent in patients with depressive and anxiety disorders, especially patients who are older, have longer duration of psychiatric disorder, and use an SSRI. Psychiatric disorders and use of antidepressants should be considered in the differential diagnosis of DED.
To evaluate in a general clinic-based cohort of patients with dry eye disease (DED) the distribution of patients with aqueous-deficient or evaporative subtype of DED.
Schirmer tests and meibomian gland dysfunction (MGD) (Foulks-Bron scoring) were evaluated in both eyes of 299 normal subjects and DED patients (218 women and 81 men) across 10 sites in the European Union and the United States. Using the more severe measurement of the 2 eyes, subjects were considered to have pure aqueous-deficient dry eye (ADDE) with Schirmer values of <7 mm and MGD grades of ≤5. Patients were classified as purely evaporative dry eye with MGD grades of >5 and Schirmer values of ≥7 mm. Subjects were placed into the mixed (hybrid) category if they exhibited both a low Schirmer value of <7 and evidence of MGD with a grade >5.
Of the 224 subjects classified with DED using an objective, composite, disease severity scale, 159 were classified into 1 of 3 categories: 79 were classified with only MGD, whereas only 23 were classified as purely aqueous deficient, and 57 showed evidence of both MGD and aqueous deficiency. Overall, 86% of these qualified DED patients demonstrated signs of MGD. The remaining 65 patients showed evidence of DED through other clinical signs, without overt evidence of MGD or ADDE, possibly because of the inherent variability of these signs.
The proportion of subjects exhibiting signs of evaporative dry eye resulting from MGD far outweighs that of subjects with pure ADDE in a general clinic-based patient cohort.
Our aim was to evaluate changes in dry eye diagnostic status following implementation of the new dry eye diagnostic criteria in Japan.
This was a multicenter cross-sectional study.
We recruited 295 individuals (81 men, 214 women, average age 43.6 ± 14.3 years) seen for general ophthalmic checkup and dry eye examinations. Using results of the Schirmer I test, tear breakup time, and fluorescein and Rose Bengal staining, patients were diagnosed as having definite dry eye (DDE), probable dry eye (PDE), or as being normal according to both the old and new Japanese dry eye diagnostic criteria.
Mean ages of normal participants and patients with PDE and DDE were 37.0 ± 10.4, 41.7 ± 14.4, and 47.7 ± 15.3 years, respectively (p < 0.001). All 37 individuals diagnosed as normal following the old criteria were also diagnosed as normal with the new diagnostic criteria. Among the 60 patients diagnosed as PDE with the old criteria, 19 (31.7%) were diagnosed as normal and 41 (68.3%) as PDE with the new diagnostic criteria. Of the 198 patients diagnosed with DDE following the old criteria, 59 (29.7%) were diagnosed as PDE and 139 (70.2%) as DDE with the new diagnostic criteria. There was no significant difference in dry eye severity index scores between the old and new diagnostic criteria.
A shift in the final dry eye diagnostic status from DDE to PDE and from PDE to normal was observed with the implementation of the new dry eye diagnostic criteria, suggesting that patients at the severe end of the dry eye disease spectrum are now diagnosed as DDE disease under the new criteria.
To estimate the prevalence and risk factors of dry eye disease (DED) in a rural setting in Japan.
Cross-sectional study.
We included 3294 subjects, aged ≥ 40 years who were in the residential registry for Koumi town.
Subjects in a rural mountain area, Koumi town, completed questionnaires designed to detect dry eye diagnosis and risk factors.
Clinically diagnosed DED was defined as the presence of a previous clinical diagnosis of DED by ophthalmologists or severe symptoms of DED (both dryness and irritation constantly or often). Current symptoms of DED and possible risk factors such as age, gender, educational history, smoking history, alcohol drinking history, height and weight, visual display terminal (VDT) use, and contact lens (CL) wear, and past/current history of certain common systemic diseases were the main outcome measures. We used logistic regression analysis to examine associations between DED and other demographic factors.
Of the 3294 eligible residents, 2791 residents (85%) completed the questionnaire. The percentage of women with a composite outcome of clinically diagnosed DED or severe symptoms (21.6%; 95% confidence interval [CI], 19.5-23.9) was higher than that of men (12.5%; 95% CI, 10.7-14.5; P<0.001). A low body mass index (BMI; odds ratio [OR], 2.07; 95% CI, 0.98-4.39), CL use (OR, 3.84; 95% CI, 1.46-10.10), and hypertension (HT) (OR, 1.39; 95% CI, 0.94-2.06) were risk factors for DED in men. Use of a VDT (OR, 2.33; 95% CI, 1.12-4.85), CL use (OR, 3.61; 95% CI, 2.13-6.10), and myocardial infarction or angina were the risk factors (OR, 2.64; 95% CI, 1.51-4.62), whereas high BMI was a preventive factor (OR, 0.69; 95% CI, 0.48-1.01) for DED in women.
Among a Japanese cohort, DED leading to a clinical diagnosis or severe symptoms is prevalent. Use of CLs was a common dry eye risk factor in both genders. The condition is more prevalent in men with low BMI, HT, and in women with myocardial infarction or angina and VDT use. Relevant measures directed against the modifiable risks may provide a positive impact on public health and quality of life of Japanese.
The authors have no proprietary or commercial interest in any materials discussed in this article.
To evaluate the effect of contact lens (CL) wear and visual display terminal (VDT) work on the ocular surface and tear functions.
Prospective case-control study.
Sixty-nine CL wearers (45 women and 24 men; mean age, 35.2 ± 7.3 years), and 102 age- and sex-matched non-CL wearers were enrolled in the study (66 women and 36 men; mean age, 36.7 ± 7.3 years). Ocular surface and tear function tests, including vital stainings (fluorescein and rose bengal), Schirmer test, tear meniscus height measurement, and tear film break-up time were performed. The subjective symptoms of dry eyes were evaluated using a dry eye symptom questionnaire. The participants were divided into 4 subgroups according to the total time of VDT work in 1 day (VDT work time in 1 day ≥ 4 hours or < 4 hours) and presence of CL wear. Main outcome measures included ocular surface vital staining scores, Schirmer test results, tear film break-up time, tear meniscus height measurement, and symptom questionnaire score.
CL users and long-term VDT workers showed significantly worse tear meniscus height values than non-CL users and short-term VDT workers (P < .001). The mean visual symptom scores in CL wearers and long-term VDT workers were significantly higher than the other groups (P < .001).
Office workers who wore CLs and spent more than 4 hours engaged in VDT work had a lower tear meniscus volume with significant dry eye and visual symptoms triggered by environmental factors.
To evaluate the use of tear osmolarity in the diagnosis of dry eye disease.
A prospective, observational case series to determine the clinical usefulness of tear osmolarity and commonly used objective tests to diagnose dry eye disease.
A multicenter, 10-site study consisting of 314 consecutive subjects between 18 and 82 years of age. Bilateral tear osmolarity, tear film break-up time (TBUT), corneal staining, conjunctival staining, Schirmer test, and meibomian gland grading were performed. Diagnostic performance was measured against a composite index of objective measurements that classified subjects as having normal, mild or moderate, or severe dry eye. The main outcome measures were sensitivity, specificity, area under the receiver operating characteristic curve, and intereye variability.
Of the 6 tests, tear osmolarity was found to have superior diagnostic performance. The most sensitive threshold between normal and mild or moderate subjects was found to be 308 mOsms/L, whereas the most specific was found at 315 mOsms/L. At a cutoff of 312 mOsms/L, tear hyperosmolarity exhibited 73% sensitivity and 92% specificity. By contrast, the other common tests exhibited either poor sensitivity (corneal staining, 54%; conjunctival staining, 60%; meibomian gland grading, 61%) or poor specificity (tear film break-up time, 45%; Schirmer test, 51%). Tear osmolarity also had the highest area under the receiver operating characteristic curve (0.89). Intereye differences in osmolarity were found to correlate with increasing disease severity (r(2) = 0.32).
Tear osmolarity is the best single metric both to diagnose and classify dry eye disease. Intereye variability is a characteristic of dry eye not seen in normal subjects.
The present study aimed at investigating the influence of the level of dynamism of two different visual display terminal tasks on spontaneous eyeblink rate, blink amplitude, and tear film integrity.
A total of 25 healthy, young volunteers participated in the study. Blink rate and blink amplitude were recorded in silent primary gaze conditions and while subjects were playing two computer games of similar cognitive demands but different rate of visual information presentation. For each experimental condition, tear volume was evaluated by measuring meniscus height and with the red phenol thread test. Fluorescein and non-invasive break-up time tests, as well as the observation of interference patterns and the estimation of the dry area extension, were employed to assess tear stability.
Statistically significant differences were revealed in blink rate (F = 595.85, p < 0.001) and blink amplitude (χ(2) = 34.00, p < 0.001), with blink rate during fast- and slow-paced game play decreasing to almost 1/3 and 1/2 of baseline levels, respectively, and with a larger percentage of incomplete blinks during dynamic tasks. Fluorescein and non-invasive break-up time tests and dry area extension were able to differentiate between experimental conditions in general (F = 408.42, p < 0.001; F = 163.49, p < 0.001; χ(2) = 20.74, p < 0.001), as well as between fast- and slow-paced games, thus suggesting that tear quality was more affected than tear volume.
Blink rate, blink amplitude, and tear film stability were compromised during the most dynamic visual display terminal task, suggesting a negative influence of not only the cognitive aspects of the task, but also of the rate at which new visual information is presented. Frequent breaks and blinking awareness training are recommended for visual display terminal users requiring prolonged periods of visually demanding dynamic computer play or work.
This study investigates the relationship between blinking, tear film break-up, and ocular symptoms for normal and dry eye subjects performing four different visual tasks.
Sixteen control and sixteen dry eye subjects performed four visual tasks (looking straight ahead, watching a movie, identifying rapidly changing letters, and playing a computer game) while blink patterns and fluorescein images of the tear film were videotaped. Pre and posttesting symptom questionnaires, querying the intensity of nine symptoms of ocular irritation, were completed by all subjects. Blink rate and blink amplitude were computed from digitized videos. The percentage of tear film break-up before the blink was calculated.
Dry eye subjects had a significantly higher blink rate (p = 0.017, t-test). Both groups blinked significantly less during the game and letter tasks (p < 0.04, t-test). Partial blinks were common as were clusters or "flurries" of rapid blinks, but there was no significant difference in blink amplitude for control and dry eye subjects. Tear film break-up in normal subjects was typically inferior; whereas dry eye subjects showed more tear break-up centrally and superiorly. Real-time video recording of tear break-up and blink behavior pointed to complex interaction between the two. Dry eye subjects shifted more toward intense ocular symptoms at posttesting (p < 0.05, Wilcoxon signed rank) than controls. Both groups showed a shift toward more corneal staining at posttesting (p < 0.05, Wilcoxon signed rank), which was typically inferior.
Reduced and incomplete blinking along with increased tear film break-up during normal visual tasks may explain the increased level of ocular discomfort symptoms reported at the end of the day, particularly in dry eye patients.
To determine the prevalence of dry eye disease (DED) and risk factors among young and middle-aged Japanese office workers using visual display terminals (VDTs).
Cross-sectional prevalence survey.
Four thousand three hundred ninety-three Japanese young and middle-aged office workers using VDTs.
Office workers completed questionnaires sent by e-mail designed to detect dry eye diagnosis and risk factors.
Clinically diagnosed DED was defined as the presence of a previous clinical diagnosis of DED by dry eye specialists or severe symptoms of DED (both dryness and irritation constantly or often). Current symptoms of DED and possible risk factors such as age, duration of VDT use, type of VDT work, environmental factors, presence of systemic diseases, systemic medicine use, smoking history, and contact lens (CL) use were the main outcome measures. We used logistic regression to examine associations between DED and other demographic factors.
Of the 4393 office workers, 3549 (80.1%) completed the questionnaire. Clinically diagnosed DED was present in 266 (10.1%) of 2640 male subjects and in 195 (21.5%) of 909 female subjects. Severe symptoms of DED were observed in 711 male and in 436 female participants. More than 4 hours of VDT use was associated with an increased risk of DED (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.40-2.02). In addition, CL use (OR, 3.91; 95% CI, 3.37-4.53) increased the risk of severe dry eye symptoms.
Dry eye disease leading to a clinical diagnosis or severe symptoms is prevalent among young and middle-aged Japanese office workers. The condition is more prevalent among females, CL wearers, and prolonged VDT users. Relevant measures directed against the modifiable risks could provide a positive impact on public health and quality of life of office workers.
The authors have no proprietary or commercial interest in any materials discussed in this article.
To estimate the ten-year incidence of dry eye in an older population and examine its association with various risk factors.
The 43 to 86 year old population of Beaver Dam, WI, was examined in 1988 to 1990 (n = 4926) and 1993 to 1995 (n = 3722). Dry eye data were first collected in 1993 to 1995. Subsequent examinations or interviews occurred in 1998 to 2000 (n = 2827) and 2003 to 2005 (n = 2124). The incidence cohort comprised 2414 subjects not reporting dry eye in 1993 to 1995. Risk factor information, ascertained in 1993 to 1995, included demographics, medical history, cardiovascular disease risk factors, medications, and life-style factors. Ten-year cumulative incidence was estimated by the product-limit method.
Over the 10-year period, 482 subjects developed a history of dry eye for an incidence of 21.6% (95% confidence interval, 19.9 to 23.3%). Incidence increased significantly (p < 0.001) with age. Incidence was greater in women (25.0%) than men (17.2%, p < 0.001). After adjusting for age, incidence was greater (p < 0.05) in subjects with arthritis, allergy or thyroid disease not treated with hormone, using antihistamines, antianxiety medications, antidepressants, oral steroids or vitamins, and poorer self-rated health. Incidence was less (p < 0.05) in subjects consuming alcohol. It was not significantly associated with blood pressure, hypertension, serum total or high density lipoprotein cholesterol, body mass, diabetes, gout, osteoporosis, cardiovascular disease, smoking, caffeine use, or taking calcium channel blockers or anticholesterol medications. In a multivariable model with time-varying covariates, increased incidence was associated with age, female gender, poorer self-rated health, antidepressant or oral steroid use, and thyroid disease untreated with hormone. It was lower for those using angiotensin-converting enzyme inhibitors or with a sedentary lifestyle.
Dry eye incidence is substantial. However, there are few associated risk factors. Some drugs (antihistamines, antianxiety drugs, antidepressants, oral steroids) are associated with greater risk, while angiotensin-converting enzyme inhibitors may be associated with lower risk.
The lysozyme test is the most sensitive test for the diagnosis of the sicca syndrome. The agar diffusion method could be used as a routine diagnostic procedure. With a diameter limit of 21½ mm of lysis under the test conditions described, one out of every 100 diagnoses would be wrong. For the rose bengal test, using a limit of score of staining intensity of 3½ one out of every 20 to
25 times a diagnostic error could be expected. With the Schirmer's 1 test, using a limit of 5½ mm wetting the filter-paper strip, one out of every six persons would be misclassified. No difference in values between men and women was found at any age level in any test. Age effects were found with lysozyme and Schirmer's 1 tests, but not with the rose bengal test.
To study the effects of exposed ocular surface area and blink rate on tear dynamics by the measurement of tear evaporation under a range of conditions.
Tear evaporation was measured in three gaze positions in 15 normal volunteers, and the ocular surface area was determined as a function of the width of the palpebral fissure. In 17 normal volunteers, the effect of blink rate on tear evaporation was assessed.
The ocular surface area was 1.2 +/- 0.27, 2.2 +/- 0.39, and 3.0 +/- 0.33 cm2 with patients looking down, ahead, and up, respectively. The corresponding tear evaporation rates per eye were 7.0 +/- 3.5, 17.6 +/- 6.6, and 23.7 +/- 6.3 x 10(-7) g/s, respectively. The tear evaporation per square meter also increased proportionally with the ocular surface area. When the blink rate was changed from 10 to 60 per minute, the tear evaporation did not change in those individuals with evaporation rates more than 7.8 x 10(-7) g/s per square centimeter, whereas it did increase with the blink rate in those whose evaporation rates were lower.
Ocular surface area and blink rate affect tear dynamics. Moderate palpebral fissure width and blink rate are necessary for the prevention of desiccation of the ocular surface.
A total of 524 consecutive new patients (195 male, 329 female, 43.4 +/- 20.8 y.o.) were evaluated for the presence of ocular fatigue and/or dry eye. Dry eye was diagnosed based on our criteria, which included symptoms, vital staining, break-up time (BUT) measurement, and the Schirmer test. Among all the patients, 21.2% (111/524) reported symptoms of ocular fatigue and 15.3% (80/524) were diagnosed as having dry eye with symptoms. Of the 111 patients who complained of ocular fatigue, 51.4% (57/111) had dry eye, which was significantly higher than the 15.3% for the entire group (p < 0.001). Additionally, 71.3% (57/80) of dry eye patients with symptoms complained of ocular fatigue, which was also significantly higher than the 21.2% among all patients (p < 0.001). Dry eye patients had a greater number of complaints (4.3 +/- 2.1 per patient) compared to controls (1.9 +/- 1.3 per patient) (p < 0.001). These findings suggest that there is a strong relation between ocular fatigue and dry eye.
To the Editor: Many persons report ocular fatigue after prolonged work at video display terminals, in part prompting legislation regulating the use of these terminals1. Since one of the main causes of ocular fatigue is dry eyes, we hypothesized that this type of work exacerbates drying of the ocular surface. The ocular surface is normally covered with a tear film composed of lipid, aqueous, and mucin layers, spread by each blink of the eye. We studied several factors affecting tear dynamics in 104 healthy office workers (45 men and 59 women; age range, 20 to 69 years), about half . . .
To study the demographics and estimate the prevalence of dry eye among elderly Americans.
A population-based prevalence study was performed in 2,520 residents of Salisbury, Maryland, aged 65 years and older as of September 1993. The population was derived from the Health Care Financing Administration Medicare database. After completing a standardized questionnaire pertaining to dry eye symptoms, 2,420 subjects underwent Schirmer and rose bengal tests and anatomic assessment of the meibomian glands.
In this population, 14.6% (363/2,482) were symptomatic, defined as reporting one or more dry eye symptoms often or all the time; 2.2% (53/2,448) were symptomatic and had a low Schirmer test result (< or = 5 mm), and 2% (48/2,432) were symptomatic and had a high rose bengal test score (> or = 5). Furthermore, 3.5% (84/2,425) were symptomatic and had either a low Schirmer score or a high rose bengal score, and 0.7% (17/2,420) were symptomatic and had both a low Schirmer score and a high rose bengal score. No association of symptoms or signs was seen with age, sex, or race. Although anatomic features of meibomianitis were associated with the presence of symptoms (P = .01), 76% (67/88) of the individuals with these anatomic features were asymptomatic; 10.5% (260/2,480) reported that they currently use artificial tears or lubricants.
Symptoms and signs of dry eye are common among the elderly but were not associated with age, race, or sex in this population-based sample of elderly Americans. Extrapolating to the United States population aged 65 to 84 years, the study yields an estimate of 4.3 million who experience symptoms of ocular irritation often or all the time.
Estimates of the prevalence of eye problems associated with using visual display terminals (VDTs) vary enormously depending on the sample tested and the research methods employed. However, most authors agree that eye problems are common among VDT users. In this paper, the relative contributions of the nature of VDT displays, workstation design, work-practices and optometric factors are discussed, drawing from the substantial body of literature which now exists on this subject. (C) 1998 The College of Optometrists. Published by Elsevier Science Ltd.
Symptoms of dry eye and dry mouth are common in the elderly and are often debilitating. Previous research on small populations has been inconsistent regarding the contribution to sicca symptoms of autoimmune markers, medication use, and other factors. The objective of this study was to determine the population prevalence of symptoms of dry eye and dry mouth and to evaluate possible risk factors.
This is a population-based study of 2481 individuals, aged 65 to 84 years, residing in Salisbury, Md, and identified by the Health Care Financing Medicare database. The main outcome measures included information on sicca symptoms, medical history, medication use, and joint examination results collected in a standardized manner. Autoimmune status was assessed in 1200 individuals by measuring antinuclear antibody, rheumatoid factor, and autoantibodies to the soluble nuclear antigens Ro/SS-A and La/SS-B by double immunodiffusion.
Approximately 27% of the population reported dry eye or dry mouth symptoms to be present often or all the time and 4.4% reported both. The prevalence of dry mouth (but not dry eye) symptoms increased with age, female sex, and white race. No association of sicca symptoms was found with rheumatoid arthritis, smoking, alcohol consumption, reproductive hormonal status, or the presence of autoantibodies. A strong, dose-response relationship was observed between sicca symptoms and the use of certain medication classes. The proportion of the population prevalence of sicca symptoms attributable to the use of drying medications was estimated at 62% for dry eye and dry mouth and 38% for dry eye or dry mouth symptoms.
Sicca symptoms are common in the elderly, and medication side effects appear to be a major underlying factor. Our results do not indicate an association between autoimmune status and sicca symptoms and do not support immunologic testing in persons with sicca symptoms in the absence of other important systemic features.
This study was designed to assess public awareness and symptoms of dry eye in Japan by a population-based, self-diagnosis study.
Two thousand five hundred participants chosen randomly from the general population were sent a questionnaire consisting of 30 questions pertaining to symptoms and knowledge of dry eye.
Awareness of the condition called "dry eye" was very high at 73%. Most of the knowledge of dry eye was obtained through the media (e.g., television, 58.8%; newspapers/magazines, 46.6%), and only a fraction of the knowledge was from physicians (6.8%). As many as 33% of participants responded that they believed they had dry eye according to the self-diagnosis criteria, of which 25% used over-the-counter eyedrops daily. The majority of eyedrop users were dissatisfied with their therapeutic effects, and only 11% sought professional help. Habits in lifestyles that were associated with self-diagnosed dry eye were contact lens use (p < 0.001), a history of allergic conjunctivitis (p = 0.002), and video display terminal tasks (p = 0.058).
Although public awareness of dry eye in Japan was high, only a minority of the population seems to consult professionals for diagnosis and symptomatic relief.
To examine risk factors for the prevalence of dry eye syndrome in a population-based cohort.
The prevalence of dry eye was determined by history at the second examination (1993-1995) of the Beaver Dam Eye Study cohort (N = 3722).
The cohort was aged 48 to 91 years (mean +/- SD, 65 +/- 10 years) and 43% male. The overall prevalence of dry eye was 14.4%. Prevalence varied from 8.4% in subjects younger than 60 years to 19. 0% in those older than 80 years (P<.001 for test of trend). Age-adjusted prevalence in men was 11.4% compared with 16.7% in women (P<.001). After controlling for age and sex, the following factors were independently and significantly associated with dry eye in a logistic model: history of arthritis (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.56-2.33), smoking status (past, OR, 1.22; 95% CI, 0.97-1.52; current, OR, 1.82; 95% CI, 1.36-2.46), caffeine use (OR, 0.75; 95% CI, 0.61-0.91), history of thyroid disease (OR, 1.41; 95% CI, 1.09-1.84), history of gout (OR, 1.42; 95% CI, 1.02-1.96), total to high-density lipoprotein cholesterol ratio (OR, for 1 unit, 0.93; 95% CI, 0.88-0.99), diabetes (OR, 1.38; 95% CI, 1.03-1.86), and multivitamin use (past, OR, 1.35; 95% CI, 1. 01-1.81; current, OR, 1.41; 95% CI, 1.09-1.82). Nonsignificant variables included body mass; blood pressure; white blood cell count; hematocrit; history of osteoporosis, stroke, or cardiovascular disease; history of allergies; use of antihistamines, parasympathetics, antidepressants, diuretics, antiemetics, or other drying drugs; alcohol consumption; time spent outdoors; maculopathy; central cataract; and lens surgery.
The results suggest several factors, such as smoking, caffeine use, and multivitamin use, could be studied for preventive or therapeutic efficacy. Arch Ophthalmol. 2000;118:1264-1268
To determine whether androgen receptors affect the fatty acid profiles of neutral and polar lipids in human meibomian gland secretions.
Meibomian gland secretion samples were obtained from both eyes of (1) women with complete androgen insensitivity syndrome, a condition characterized by dysfunctional androgen receptors, and (2) age-matched female and male controls. Samples were processed for high-performance liquid chromatography, mass spectrometry, or both and for analysis of the mass spectra of neutral and polar lipid fatty acid fragment ions by 3 different methods.
Androgen receptor dysfunction is associated with significant alterations in the appearance of numerous molecular species in the neutral and polar lipid fractions of meibomian gland secretions. The ability to detect these differences, and to assess their nature and extent, was facilitated by the use of several analytic approaches. Sex-related differences exist in the expression of a variety of neutral and, especially, polar fatty acid products in meibomian gland secretions.
Androgens exert a significant effect on neutral and polar lipids in human meibomian gland secretions, and these hormonal effects may be mediated through androgen receptors.
To estimate the 5-year incidence of dry eye and to examine its association with risk factors.
The population of Beaver Dam, Wis, that was 43 to 84 years of age (n = 5924) was examined in the 1988-1990 (n = 4926), 1993-1995 (n = 3722), and 1998-2000 study phases (n = 2962). At the 1993-1995 examination, when dry eye data were first collected, and the 1998-2000 examination, 2783 subjects participated, and 44 were interviewed. Of these, 2802 provided dry eye history. The incidence cohort consisted of 2414 subjects not reporting dry eye in the 1993-1995 examination. Risk factor information was ascertained at the 1993-1995 examination and included demographics, medical history, cardiovascular disease risk factors, medications, and lifestyle factors.
During the 5-year interval between examinations, a history of dry eye developed in 322 of 2414 subjects, for an incidence of 13.3% (95% confidence interval [CI], 12.0%-14.7%). Incidence was significantly associated with age (P<.001). After adjusting for age, incidence was greater in subjects with a history of allergy or diabetes, who used antihistamines or diuretics, and with poorer self-rated health (P<.05). Age-adjusted incidence was less in subjects using angiotensin-converting enzyme inhibitors or consuming alcohol (P<.05). It was not significantly associated with sex, blood pressure, hypertension, serum total or high-density lipoprotein cholesterol level, body mass index, history of arthritis, gout, osteoporosis, cardiovascular disease, thyroid disease, or smoking, and use of caffeine, vitamins, antianxiety medications, antidepressants, calcium channel blockers, or anticholesterolemics.
Incidence of dry eye is substantial. However, there are few associated risk factors. Some drugs (eg, diuretics and antihistamines) are associated with a greater risk, whereas others (angiotensin-converting enzyme inhibitors) are associated with lower risk.
We have investigated the effects of a range of workstation factors upon the visual symptoms experienced by a group of 92 visual display terminal (VDT) users. Subjects in the study kept a diary over five consecutive working days in which they recorded the types of visual and postural symptoms which occurred and the types of work tasks being performed. Each subject's workstation was analysed for screen legibility and stability, discomfort and disability glare, and required head postures. By the use of multiple regression analysis techniques we have considered the relative contribution of these factors to the symptoms reported by the users of these workstations. Screen legibility significantly influenced the occurrence of symptoms of ocular discomfort and vertical head movements significantly affected the incidence of postural/headache symptoms.
To determine whether aging is associated with significant alterations in the polar and neutral lipid profiles in human meibomian gland secretions.
Meibomian gland secretions were collected from both eyes of younger and older men and women. Samples were processed for high-performance liquid chromatography or mass spectrometry and for the analysis of associated spectra of fragment ions. Subjects also underwent slitlamp evaluations of the eyelid.
Aging is associated with numerous significant alterations in the lipid profiles of human meibomian gland secretions. Analysis of polar and neutral lipid patterns identified ions that were significantly different in secretions of younger vs older men and women, as well as ions that varied significantly only between men and women. Correlation coefficients within, but not between, groups were high. Aging was accompanied by increased opacity of meibomian gland secretions and by eyelid and eyelid margin changes.
Aging is associated with significant sex-related alterations in the polar and neutral lipid profiles of human meibomian gland secretions.
The observed changes may contribute to the age-related increase in the prevalence of dry eye syndromes.
To evaluate the impact of dry eye syndrome (DES) on vision-associated quality of life.
Cross-sectional study.
We identified 450 participants in the Women's Health Study (WHS) and 240 participants in the Physicians' Health Study (PHS) and sent a supplementary questionnaire asking how much their everyday activities were limited by symptoms of dry eye and to what degree problems with their eyes limited them in reading, driving, working at the computer, their professional activity, and watching television. By design, one-third of study subjects had clinically diagnosed DES or severe symptoms and two-thirds did not. We used logistic regression to examine relationships of DES with reported problems with everyday activities in each cohort and pooled estimates using meta-analysis methods.
Of the participants invited, 85% completed the supplementary questionnaire, including 135 WHS and 55 PHS participants with DES, and 250 WHS and 149 PHS participants without DES. Controlling for age, diabetes, hypertension, and other factors, those with DES were more likely to report problems with reading ([odds ratio] OR = 3.64, 95% [confidence interval] CI 2.45 to 5.40, P < .0001); carrying out professional work (OR = 3.49, 95% CI 1.72 to 7.09, P= 0.001); using a computer (OR = 3.37, 95% CI 2.11 to 5.38, P < .0001); watching television (OR = 2.84, 95% CI 1.05 to 7.74, P = .04); driving during the day (OR = 2.80, 95% CI 1.58 to 4.96, P < .0001); and driving at night (OR = 2.20, 95% CI 1.48 to 3.28, P < .0001).
DES is associated with a measurable adverse impact on several common and important tasks of daily living, further implicating this condition as an important public health problem deserving increased attention and resources.
Blink rate, blink amplitude, and tear film integrity during dynamic visual display terminal tasks
- G Cardona
- C Garcia
- C Seres
- M Vilaseca
- J Grispets
Cardona G, Garcia C, Seres C, Vilaseca M, Grispets J. Blink
rate, blink amplitude, and tear film integrity during dynamic
visual display terminal tasks. Curr Eye Res 2011;36(3):
190-197.