Changes in Distribution of Dry Eye Disease by the New 2016 Diagnostic Criteria from the Asia Dry Eye Society

Abstract

Dry eye disease (DED) is a disorder of the tear film. Here, we delineate the changes in distribution of DED after diagnostic criteria changes from the 2006 Japanese Diagnostic Criteria to the 2016 Asia Dry Eye Society criteria. We included 250 right eyes of 250 patients and all patients completed ophthalmic assessments for DED. The 2006 criteria classified patients into definite DED, probable DED, and non-DED based on subjective symptoms, tear function, and/or vital staining. The 2016 criteria eliminated probable DED and classified patients into definite DED or non-DED based on subjective symptoms and decreased tear break-up time. We examined how probable DED patients were reclassified by the 2016 criteria. By the 2006 criteria, 38.8% (97/250) of patients had definite DED, 35.6% (89/250) had probable DED, and 25.6% (64/250) had non-DED. By the 2016 criteria, 66.8% (167/250) had definite DED and 31.2% (83/250) had non-DED. Among patients with probable DED using the 2006 criteria, 79.8% (71/89) were reclassified as definite DED and 20.2% (18/89) were reclassified as non-DED using the 2016 criteria. Our data revealed that prevalence of definite DED increased because most probable DED patients were reclassified as definite DED after changes in the diagnostic criteria.

Figure 1

The percentage changes in patients classified as definite DED under the 2016 criteria from the 2006 criteria. (A) Changed distribution of definite DED between 2006 and 2016 criteria by age and sex. More men and patients ≥ 65 years old had definite DED by the 2016 criteria. (B) Change distribution of probable DED to definite DED between the 2006 and 2016 criteria. 79.8% of probable DED patients were reclassified as definite DED according to the 2016 criteria. In the subgroup analysis, probable DED patients who were < 65 years old were often reclassified as definite DED. Data are considered statistically significant at *p < 0.05. Chi-square test was used to compare categorical variables.

Figure 2

Changes in the scatter plot of Schirmer test I values and TBUT among four subtypes of patients with definite DED per the 2006 and 2016 criteria. Figures show the scatter plot of Schirmer test I results and TBUT by the (A) 2006 criteria and the (B) 2016 criteria. TBUT; tear break-up time.