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K.K. Nichols, L.A. Jones, R.D. Jackson, K. Zadnik; Dry Eye in Postmenopausal Women Enrolled in the Observational Study Cohort of the Women's Health Initiative . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2462.
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Purpose: The purpose of this study was to evaluate the health of the ocular surface in women enrolled in the Observational Study (OS) cohort of the Women’s Health Initiative (WHI) at the Ohio State University. Methods: Two hundred seventy-seven WHI-OS participants (age range 54-86 years) were recruited by mail and were seen for an evaluation of the ocular surface including assessment of symptoms of ocular irritation, tear film osmolarity, tear meniscus height, Meibomian gland blockage, fluorescein tear break-up time, corneal fluorescein staining, conjunctival lissamine green staining, and the Schirmer I test. The participant's dry eye status was categorized as using two methods: (1) self-report of dry eye symptoms by a single question, and (2) self-report of a previous dry eye diagnosis. At this sample size, we have 80% power (α=0.05) to detect the following clinically important differences: Schirmer I test, 3 mm; tear meniscus height, 0.1mm; tear break-up time, 1 second; and tear osmolarity, 10 mOsm. Results: Of the sample, 44.0% reported experiencing dry eye symptoms over the past three months, 31.2% reported a previous dry eye diagnosis, and 54.2% reported current hormone replacement therapy usage. Dry eye test results revealed that 15.4% had a Schirmer I test ≤5 mm/5 min., 19.9% had a fluorescein staining score ≥3, and 26.3% had a lissamine green staining score ≥3. The average osmolarity for the sample was 308.7 ± 25.1 mOsm. When categorized as dry eye by (1) self-reported symptoms and by (2) previous diagnosis, no statistically significant differences were found for tear break-up time, Schirmer test results, lissamine green and fluorescein staining, osmolarity, and tear meniscus height. In addition no difference was shown between patients using or not using hormone replacement therapy. Significantly more patients with symptoms or a previous dry eye diagnosis reported using artificial tears. When controlling for artificial tear use, only tear break-up time was significantly lower for those with a previous dry eye diagnosis (p = 0.03) Conclusions: Contrary to previous reports, we found no significant difference in self-reported symptoms or a previous dry eye diagnosis in women taking or not taking hormone replacement therapy. The lack of significance in diagnostic test results when categorized by self-reported symptoms or a previous diagnosis may indicate that these methods are poor in differentiating those with and without dry eye disease, further adding to the dry eye diagnostic quandary.
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