New study focuses on scope of dry eye disease in U.S.

More than 16 million Americans—including twice as many women than men—endure dry eye disease (DED), according to a recently released study.

The numbers of people with dry eye disease have varied in studies, according to authors of an online article in the July 2017  American Journal of Ophthalmology that attempts to shed light on the prevalence of DED among adults. Its contributors are researchers at Harvard University, the University of Utah and the global biotechnology company Shire.

In the study researchers looked at data from the 2013 National Health and Wellness Survey by Kantar Health, a leading health care consulting firm. The study found that:

• Age matters. The prevalence of DED among 18 to 34-year-olds was 2.7% compared to 18.6% among adults age 75 and older.
• Gender matters. Twice as many women (8.8%) had been diagnosed than men (4.5%), or about 11.1 million women compared to about 5.3 million men.
• Many DED cases may go undiagnosed. An estimated 6 million people in the survey reported "having experienced DED symptoms but had not been diagnosed with DED (Symptomatic-Undiagnosed.)"

Takeaways for doctors of optometry

Caroline Blackie, O.D., Ph.D., practices in Burlington, Massachusetts. She also is a research scientist and director of medical affairs at TearScience Inc., a medical device company that focuses on the treatment of Meibomian Gland Dysfunction (MGD), a leading cause of dry eye.

The prevalence of DED comes as no surprise to Dr. Blackie. Referring to the higher number of women with DED, Dr. Blackie noted that "hormonal changes have a significant impact on many components of health. We know that the Meibomian glands are not exempt."

Further, Dr. Blackie says, the diagnostic criteria for DED continue to evolve. She suspects the percentage of people with DED might be even higher, given the changing definition, never mind the undiagnosed cases.

"Our threshold for diagnosis in 2017 is not what it was in 2013 or earlier (the data from which the study reports)," she says. "Not only that but also public awareness of dry eye has increased over the past five years. This also will drive up diagnoses going forward."

So what might be the takeaways from this study for doctors of optometry?

First, that the prevalence of diagnosed dry eye is "significant," Dr. Blackie says. Second, that foresight is called for, she says.

"The conventional style of practice in dry eye cases is to wait for the patient to tell you there is a problem," Dr. Blackie says. "This is suboptimal and reactive care. We can do so much better! We know MGD is the leading cause of dry eye. Almost every patient you see with dry eye has MGD, which negatively impacts every aspect of ocular surface health including tear film host-defense, corneal nerve health, conjunctival health and much more."

She adds, "We can look for and treat MGD long before our patients develop chronic inflammation and discomfort. I can easily evaluate every patient for MGD by evaluating Meibomian gland function and structure. If I evaluate for MGD routinely, I can catch it early and treat it effectively. We don't need to wait for our patients to develop dry eye before we educate them and assess their risk."