Prevalence and associated risk factors of dry eye disease in 16 northern West bank towns in Palestine: a cross-sectional study

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Abstract

Background

Dry Eye Disease (DED) is a multifactorial disease of the interpalpebral ocular surface and tear film that leads to discomfort, fatigue and disturbance in vision. DED affects patients’ quality of life and leads eventually to decrease of productivity. Moreover, it has a considerable socioeconomic burden. It is a growing underdiagnosed health issue and the possible associated risk factors are very common and keep growing worldwide.

Purpose

To assess the prevalence of DED and potential associated risk factors in the Northern West Bank of Palestine.

Methods

A cross sectional study was conducted in 16 selected towns in Northern West Bank governorates during December 2016 to September 2017. An interviewer-assisted Ocular Surface Disease Index (OSDI) questionnaire was used to study DED symptoms in the study population. Further evaluation of clinical signs of DED was performed using the following objective tests: tear film break-up time (TBUT), fluorescein corneal staining (FL/S) and Schirmer test. Subjects with an OSDI score of 13 or above were considered symptomatic of DED, and DED was defined if an OSDI score ≥ 13 is accompanied by at least one of the following signs in the worse eye: TBUT ≤10 s, Schirmer score ≤ 5 mm and fluorescein corneal staining ≥ grade 1.

Results

Seven hundred sixty-nine subjects were recruited from the general non-clinical population in the West Bank. The mean age of participants was 43.61 ± 18.57 years ranging from 18 to 90 years. Females constitute 52.7% of the study population. Based on the diagnostic criteria, the prevalence of DED was 64% (95% confidence interval 60.6–67.3). DED was significantly associated with female gender p = (0.001) and older age p = (0.001).

Conclusion

The prevalence of DED is high in the study population. Older age and female gender were associated risk factors with the development of DED.

Related collections

Most cited references 46

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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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The purpose of this report was to examine the relation between clinical tests and dry eye symptoms in patients with dry eye disease. Seventy-five patients with dry eye disease (ICD-9 code 375.15) were included in these analyses. There was no specific entry criterion for enrollment in addition to a previous dry eye diagnosis in this clinic-based sample. Patients represented varying types and severity of dry eye disease and were previously diagnosed by clinic attending doctors in this university clinic setting. The study examination included a symptom interview that assessed dryness, grittiness, soreness, redness, and ocular fatigue. The interview was followed by a clinical dry eye examination conducted in the following sequence: meibomian gland assessment, tear meniscus height, tear breakup time test, fluorescein staining, the phenol red thread test, Schirmer test, and rose bengal staining. Partial Spearman correlation coefficients, the Wilcoxon rank sum test, chi 2 test, and multivariate logistic regression were used to evaluate the relationship between dry eye tests and symptoms. Symptoms were generally not associated with clinical signs in patients with dry eye disease. There were no significant correlations between signs and symptoms after adjustment for age and artificial tear use. The rank of each clinical test result did not statistically differ when stratified by the presence of patient symptoms in Wilcoxon rank sum analyses. Likewise, the frequency of patient symptoms did not differ statistically when stratified by a positive clinical test result in chi 2 analyses. In multivariate logistic regression analyses, no clinical test significantly predicted frequently reported symptoms after adjustment for age and artificial tear use. These results suggest a poor relation between dry eye tests and symptoms, which represents a quandary in dry eye clinical research and practice.

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The pathophysiology, diagnosis, and treatment of dry eye disease.

Elisabeth Messmer (2015)

Dry eye disease (DED) is common; its prevalence around the world varies from 5% to 34%. Its putative pathogenetic mechanisms include hyperosmolarity of the tear film and inflammation of the ocular surface and lacrimal gland. Dry eye is clinically subdivided into two subtypes: one with decreased tear secretion (aqueous-deficient DED), and one with increased tear evaporation (hyperevaporative DED).

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Author and article information

Contributors

Yousef Shanti: yousef.isam.shanti@gmail.com , yousef.shanti@najah.edu

Reham Shehada: rehamshehada@yahoo.com

May M. Bakkar: mmbakkar@just.edu.jo

Jamal Qaddumi: jamal9877@najah.edu

Journal

Journal ID (nlm-ta): BMC Ophthalmol

Journal ID (iso-abbrev): BMC Ophthalmol

Title: BMC Ophthalmology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2415

Publication date (Electronic): 13 January 2020

Publication date PMC-release: 13 January 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 26

Affiliations

[1 ]ISNI 0000 0004 0631 5695, GRID grid.11942.3f, Department of Ophthalmology, , An-Najah National University Hospital, ; 44839 Nablus, Palestine

[2 ]ISNI 0000 0004 0631 5695, GRID grid.11942.3f, Department of Medicine, College of Medicine and Health Sciences, , An-Najah National University, ; 44839 Nablus, Palestine

[3 ]ISNI 0000 0004 4906 9746, GRID grid.469941.7, Department of Ophthalmology, The Islamic Hospital, ; Amman, Jordan

[4 ]ISNI 0000 0001 0097 5797, GRID grid.37553.37, Faculty of Applied Medical Sciences, Department of Allied Medical Sciences, , Jordan University of Science and Technology (JUST), ; Irbid, 22110 Jordan

[5 ]ISNI 0000 0004 0631 5695, GRID grid.11942.3f, Department of Nursing, College of Medicine and Health Sciences, , An-Najah National University, ; 44839 Nablus, Palestine

Article

Publisher ID: 1290

DOI: 10.1186/s12886-019-1290-z

PMC ID: 6958733

PubMed ID: 31931756

SO-VID: fd6ef6dd-2c46-4890-9bc2-b3dcbc507088

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.