Prevalence and associations of dry eye disease and meibomian gland dysfunction in the ural eye and medical study

Abstract

To assess the prevalence of dry eye disease (DED) and Meibomian gland dysfunction (MGD) in a population in Russia. The population-based Ural Eye and Medical Study was conducted in an urban and rural region in Bashkortostan/Russia and included 5899 (80.5%) out of 7328 eligible persons, aged 40 + years. DED and MGD were assessed by Schirmer´s test, slit-lamp based examination of the Meibomian glands, and an interview with DED-related questions. The study included 5153 (87.4%) individuals with DED and MGD assessments (mean age: 58.5 ± 10.5 years). The mean Schirmer´s test result was 11.8 ± 6.8 mm and 12.5 ± 7.1 mm for the right/left eye, with a result of ≤ 5 mm measured in 1098 (21.3%; 95% confidence intervals (CI) 20.2, 22.4) of the worse eyes. The mean subjective dry eye symptoms score was 1.37 ± 1.82. MGD grade 1 (telangiectasia at the lid margin), 2, 3, 4 or any grade in the worse eye was diagnosed in 901 (21.1%), 1161 (27.1%), 158 (3.7%), 32 (0.7%), and 2252 (52.6%; 95% CI 51.1, 54.1) eyes respectively. The prevalence of DED diagnosis #1, #2 and #3 (Schirmer´s test ≤ 5 mm, and dry eye score ≥ 1, ≥ 2, and ≥ 3, respectively), #4 (dry eye score ≥ 1, Schirmer test ≤ 5 mm, MGD grade 1 +), and #5 (dry eye score ≥ 1, Schirmer test ≤ 5 mm, MGD grade 2 +) were 598/5142 (11.6%), 426/5153 (8.3%), 273/5142 (5.3%), 335/5142 (6.5%), and 186/5142 (3.6%), respectively. Mean depression score as applied was 5.1 ± 3.8. Higher DED prevalence (definition #4) was associated (multivariable analysis) with female sex (odds ratio (OR) 1.71; 95% CI 1.31, 2.22; P < 0.001), higher depression score (OR 1.04; 95% CI 101, 1.07; P = 0.009), and higher prevalence of thyroid disease history (OR 1.63; 95% CI 1.19, 2.24; P = 0.006). DED and MGD were common in this rural and urban population, and their prevalence was associated with female sex, thyroid disease, and depression.

Figure 1

Graph showing the distribution of the Schirmer´s test result stratified by age and sex in the Ural Eye and Medical Study.

Figure 2

Histogram showing the distribution of the total score of the dry eye symptoms in the Ural Eye and Medical Study The prevalence and degree of a DED were assessed by specific questions in the questionnaire and by additional physical examinations. The questions were: 1) Do our eyes feel dry; 2) Do you ever feel a gritty or sandy sensation in your eye; 3) Do your eyes ever have a burning sensation; 4) Are your eyes ever red; 5) Do you notice much crusting on your lashes; and 6) Do your eyes ever get stuck in the morning. All questions were answered using a scale of grade 0 for “never”, grade 1 for “rarely or sometimes”, and grade 2 for “frequently or always”. A quantitative grading score of the subjective dry eye symptoms was obtained by summarizing the grades of the answers to the six questions (0–12).

Figure 3

Graph showing the distribution of Meibomian gland dysfunction stratified by age and sex in the Ural Eye and Medical Study.

Figure 4

Graph showing the distribution of the prevalence of dry eye disease (definition #2: dry eye symptoms score was ≥ 2 and Schirmer´s test of < 5 mm) stratified by age in the Ural Eye and Medical Study.

Figure 5

Graph showing the distribution of the prevalence of dry eye disease (definition #4: dry eye symptoms score was ≥ 1, Schirmer test ≤ 5 mm, and a Meibomian gland dysfunction grade of 1 (telangiectasia at the lid margin) or higher) stratified by age in the Ural Very Old Study.