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      Dry Eye Disease: Consideration for Women's Health

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          Abstract

          Dry eye disease (DED) is a multifactorial disorder of the ocular surface and tear homeostasis that can result in discomfort, pain, and visual disturbance. Untreated, DED can become chronic, progressive, and significantly affect an individual's quality of life. Women are disproportionately affected by DED, are diagnosed at a younger age, and experience more severe symptoms compared with men. DED is associated with a wide range of comorbid conditions; there is a strong association between DED and autoimmune disorders, especially those that affect women at many times the rate of men. Treatment response questionnaires indicate women respond better to a wellness model of treatment for DED than men. Furthermore, women's health care-seeking behaviors provide opportunities for general practitioners, specialists, and women's health centers to help identify women with DED or at risk for DED for referral to an eye care specialist. This review of the prevalence of DED in women, and gender and sex-specific aspects of DED, highlight a significant opportunity for action. Earlier diagnosis and treatment of this common but burdensome condition could significantly improve a woman's quality of life.

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          Gender differences in the utilization of health care services.

          K D Bertakis, R Azari, L J Helms … (2000)
          Studies have shown that women use more health care services than men. We used important independent variables, such as patient sociodemographics and health status, to investigate gender differences in the use and costs of these services. New adult patients (N = 509) were randomly assigned to primary care physicians at a university medical center. Their use of health care services and associated charges were monitored for 1 year of care. Self-reported health status was measured using the Medical Outcomes Study Short Form-36 (SF-36). We controlled for health status, sociodemographic information, and primary care physician specialty in the statistical analyses. Women had significantly lower self-reported health status and lower mean education and income than men. Women had a significantly higher mean number of visits to their primary care clinic and diagnostic services than men. Mean charges for primary care, specialty care, emergency treatment, diagnostic services, and annual total charges were all significantly higher for women than men; however, there were no differences for mean hospitalizations or hospital charges. After controlling for health status, sociodemographics, and clinic assignment, women still had higher medical charges for all categories of charges except hospitalizations. Women have higher medical care service utilization and higher associated charges than men. Although the appropriateness of these differences was not determined, these findings have implications for health care.
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            TFOS DEWS II Tear Film Report

            Tom J. Millar, Pablo Argüeso, Gordon Laurie … (2017)
            The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED). The Subcommittee reviewed biophysical and biochemical aspects of tears and how these change in DED. Clinically, DED is characterized by loss of tear volume, more rapid breakup of the tear film and increased evaporation of tears from the ocular surface. The tear film is composed of many substances including lipids, proteins, mucins and electrolytes. All of these contribute to the integrity of the tear film but exactly how they interact is still an area of active research. Tear film osmolarity increases in DED. Changes to other components such as proteins and mucins can be used as biomarkers for DED. The Subcommittee recommended areas for future research to advance our understanding of the tear film and how this changes with DED. The final report was written after review by all Subcommittee members and the entire TFOS DEWS II membership.
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              Prevalence of dry eye syndrome among US women.

              Debra Schaumberg, David A. Sullivan, Julie Buring … (2003)
              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. we surveyed 39,876 US women participating in the Women's Health Study about a history of diagnosed DES and dry eye symptoms. 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 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.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Womens Health (Larchmt)
                Journal ID (iso-abbrev): J Womens Health (Larchmt)
                Journal ID (publisher-id): jwh
                Title: Journal of Women's Health
                Publisher: Mary Ann Liebert, Inc., publishers (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
                ISSN (Print): 1540-9996
                ISSN (Electronic): 1931-843X
                Publication date (Print): 01 April 2019
                Publication date (Electronic): 10 April 2019
                Publication date PMC-release: 10 April 2019
                Volume: 28
                Issue: 4
                Pages: 502-514
                Affiliations
                [ 1 ]Matossian Eye Associates, Pennington and Pennington, New Jersey.
                [ 2 ]Ophthalmic Consultants of Long Island, Lynbrook, New York.
                [ 3 ]Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
                [ 4 ]School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama.
                [ 5 ]School of Optometry and Vision Science, University of Waterloo, Ontario, Canada.
                [ 6 ]Division of Cornea and Refractive Surgery, Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina.
                Author notes
                [*]Address correspondence to: Cynthia Matossian, MD, FACS, Matossian Eye Associates, 2 Capital Way #326, Pennington, NJ 08534 cmatossian@ 123456matossianeye.com
                Article
                Publisher ID: 10.1089/jwh.2018.7041
                DOI: 10.1089/jwh.2018.7041
                PMC ID: 6482917
                PubMed ID: 30694724
                SO-VID: 7e9c88f6-6d88-411f-810a-8fbb71157d10
                Copyright © © Cynthia Matossian et al. 2019; Published by Mary Ann Liebert, Inc.
                License:

                This Open Access article is distributed under the terms of the Creative Commons License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 1, Tables: 4, References: 135, Pages: 13
                Categories
                Subject: Original Articles

                Keywords: epidemiology,postmenopausal women,primary care,dry eye disease,autoimmune disease,comorbid conditions,quality of life,chronic,progressive
                Data availability:
                Keywords: epidemiology, postmenopausal women, primary care, dry eye disease, autoimmune disease, comorbid conditions, quality of life, chronic, progressive

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