Transcript Prevalence rates

Prevalence of Dry Eye Disease
among Elderly Korean Population
Financial Disclosure: None
Sang Beom Han, MD,1 Joon Young Hyon, MD,1
Won Ryang Wee, MD,2,3 Jin Hak Lee, MD,1, 3
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National
University Bundang Hospital1, Seongnam, Korea
Department of Ophthalmology, Seoul National University College of Medicine2, Seoul, Korea
Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute 3,
Seoul, Korea
Background
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Prevalence of Dry Eye
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Several population-based studies have reported prevalence of dry
eye from 4.3% to 52.1%.
Large disparity in reported prevalence of dry eye
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Lack of standardized diagnostic definition
Difference in the study population.
Risk Factors of Dry Eye
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A few risk factors including old age, female gender, and hazardous
environment have been assumed to be associated with dry eye.
Ethnic difference in the prevalence of dry eye between Caucasian
and Asian population has been suggested.
Schein et al. Am J Ophthalmol 1997;124:723-8.
Shimmura et al. Cornea 1999;18:408-11.
Purpose
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To assess the population-based prevalence of dry eye in
elderly Korean population.
To investigate the associated risk factors and affected
quality of life.
Conducted from May 2008 to February 2009 in Yongin city,
Korea.
Why Yongin?
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Yongin was considered to be an ideal community for a populationbased study in Korea since it is one of the largest cities with
rural/urban mixture in Korea.
Sample
Towns within Yongin were randomly selected to cover about
10,000 residents aged 65 years old or above.
10% of them were randomly drawn, and finally
1,060 elderly subjects were sampled.
657 agreed to participate in this study and
completed a symptom questionnaire.
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Two-Stage Design
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Phase I population survey
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Dry Eye Questionnaire (DEQ)
Schirmer test
DEQ
During recent 2 weeks
1.Do your eyes feel dry?
2.Do you feel gritty or sandy sensation in your eyes?
3.Do your eyes ever have a burning sensation?
4.Do your eyes ever feel sticky?
5.Do your eyes ever feel watery or tearing?
6.Are your eyes ever red?
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Allowed responses to the questions were ‘none”, ‘rarely’, ‘sometimes’, and
‘often or all the time’.
Dry eye was defined as having one or more symptoms often or all the time.
Phase II evaluation
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Tear film breakup time (BUT) test
Fluorescein stain
Examination of meibomian gland dysfunction
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Positive signs were defined as
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Tear film BUT ≤10 seconds
Schirmer test score ≤ 5 mm
Fluorescein score ≥ 1
or the presence of meibomian gland disease
Statistical Analysis
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In each subject, the worse eye was used for analyses.
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Standardized prevalence rates were also estimated using
the direct standardization method.
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The prevalence rates were adjusted by age, gender, and urbanicity
to the total Korean population, as given in the 2005 national census.
Association between demographic variables (age, sex, and
area) and dry eye symptoms or signs was evaluated using
Pearson Chi-square tests.
Results
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Total 657 subjects
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Mean age was 72.0 ± 5.9 years (mean ± SD, range 65-95)
M : F ratio was 48.2%: 51.8% (317 : 340)
Schirmer test was completed in 648 subjects
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139 subjects completed this Phase II evaluation.
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Prevalence of Dry eye
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The crude prevalence rate, define as presence of one or more of the
six dry eye symptoms, was 30.3%.
Sex, age, and area adjusted prevalence based on the Korea 2005
census population was 33.2% (95% CI 28.9 -37.4).
Prevalence rates
According to the potential predictors
Positive dry eye symptoms
Variables
No
Crude rate
%
Adjusted rate
% (95% CI)
Total rate
199 / 657
30.3
33.2 (28.9 -37.4)
Age groups
65-69
70-74
75-79
80-84
≥85
84 / 276
52 / 188
36 / 113
15 / 52
12 / 28
30.4
27.7
31.9
28.8
42.9
34.3 (27.8-40.7)
33.3 (25.5-41.0)
35.1 (24.7-45.5)
31.1 (16.3-45.9)
35.7 (13.9-57.5)
P value
0.575
Sex
Male
Female
81/ 317
118 / 340
25.6
34.7
29.8 (24.1-35.5)
37.7 (31.6-43.8)
0.011
1.55
(1.11 - 2.17)
0.001
1.81
(1.29 – 2.55)
Area
Urban
Rural
125 / 346
74 / 311
36.1
23.8
36.5 (31.4-41.6)
23.7 (19.0-28.5)
Odds Ratio
(95% CI)
Dry Eye Signs
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Frequency of positive dry eye tests according to the
presence or absence of dry eye symptoms.
No (%)
Variables
P value
Odds Ratio
(95% CI)
Positive dry eye
symptoms
Negative dry eye
symptoms
Schirmer I test ≤ 5 mm
63 / 192 (32.9%)
113 / 456 (24.8%)
BUT ≤10 seconds
63 / 74 (85.1%)
56 / 65 (86.1%)
1.000
0.92 (0.36 – 2.38)
Fluorescein score ≥ 1
29 / 74 (39.1%)
21 / 65 (32.3%)
0.47
1.35 (0.67 -2.71)
Presence of meibomian
gland disease
40 / 74 (54.1%)
32 / 65 (49.2%)
0.61
1.21 (0.62 – 2.37)
0.042* 1.48 (1.03 – 2.14)
*Only Schirmer test score was shown to have significant association with positive
dry eye symptoms, although the test also showed high false-positive rate
Risk factors
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Ethnicity
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Gender
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High prevalence of 33.2% in this study is similar to those among
Asians, but much higher than those among Caucasians.
Sex hormones may influence ocular surface condition through their
effects on lacrimal gland, meibomian glands, conjunctival goblet cell
density, and ocular surface sensitivity.
Area
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The exact cause is yet to be elucidated, although air pollution in the
urban region may, at least in part, contribute to the difference.
Conclusion
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Dry eye is very common condition with an estimated
national prevalence of 33.2% among elderly Koreans
population.
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Women and urban dwellers are more likely to suffer from
dry eye symptoms.