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Jelle Vehof, Diana Kozareva, Pirro Hysi, Samantha Fahy, Kenan Direk, Tim Spector, Christopher Hammond; Prevalence and Determinants of Dry Eye Disease in a British Female Cohort. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2665.
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To estimate the prevalence and determinants of dry eye disease (DED) in a female cohort in the United Kingdom.
A population based cross-sectional association study was performed including 3824 female twin volunteers from 2410 families, aged 20 to 87 years (mean age 57.1 years, standard deviation 13.1 years), from the TwinsUK adult registry held at St Thomas’ Hospital, London. A questionnaire was used to evaluate DED and several determinants. DED cases were defined when a previous diagnosis of DED by a clinician was present and artificial tears were currently used. The presence of DED symptoms in the last three months was also evaluated. Determinants measured were age, contact lens wear, a clinical history of several systemic diseases, systemic medication and self-rated health. Blood was taken to measure prolactin levels. Prevalence was estimated by decades of age. Binary logistic regression, corrected for age, was used to examine the association between DED and determinants.
Of the 3824 females 367 (9.6%) were assigned as a case of DED, and 3171 (82.9%) as a control. The prevalence increased every age decade, from 2.7% in 20 to 30 years, to 20.0% in 80 years and older. 794 (20.8%) had dry eye symptoms in the preceding three months, which was also more prevalent with increasing age. Determinants that were significantly associated with DED were age, contact lens wear, asthma, eczema, allergy, cataract surgery, rheumatoid arthritis, osteoarthritis, migraine and stroke. The highest effect sizes were found with depression (odds ratio (OR) 1.67 (95% CI 1.27-2.19)), irritable bowel syndrome (OR 2.24 (95% CI 1.76-2.85)) and chronic widespread pain syndrome (OR 2.13 (95% CI 1.42-3.18) (all p<0.0005). No association with prolactin levels was found. DED cases scored 0.3 points lower on a 5-point scale of self-perceived health, compared to controls (p=0.001).
Dry eye disease is common and increases with age within this cohort of female twins. We confirmed established risk factors, including atopy, eye surgery and arthritis, for the first time in a British population. We also found factors involving psychosomatization, that, similar to other chronic pain syndromes, may underly determination of DED and its symptoms.
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