July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Gender Disparity in how Dry Eye Symptoms are influenced by Pain Sensitivity
Author Affiliations & Notes
  • Wing Li
    UC Berkeley, Millbrae, California, United States
  • Meng C Lin
    UC Berkeley, Millbrae, California, United States
  • Footnotes
    Commercial Relationships   Wing Li, None; Meng Lin, None
  • Footnotes
    Support  N/A
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 4905. doi:
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      Wing Li, Meng C Lin; Gender Disparity in how Dry Eye Symptoms are influenced by Pain Sensitivity. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4905.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : It is not well understood why females have a higher dry eye prevalence rate than males, as studies have not found a pronounced difference in ocular surface characteristics between them. Interestingly, an inter-gender difference in pain perception has been noted and recent studies have found that pain sensitivity is associated with dry eye symptomology. This study attempts to discern if the gender disparity in dry eye prevalence rates may be partially attributed to differences in pain perception.

Methods : Subjects were seen for one visit where they were asked to fill out a set of questionnaires consisting of the Pain Sensitivity Questionnaire (PSQ), Ocular Surface Disease Index (OSDI), Standardized Patient Evaluation of Eye Dryness (SPEED), and visual analog scales (VAS) related to ocular comfort and dryness. An ocular surface assessment was then performed, which consisted of examining the tear meniscus height (TMH), tear-film lipid layer thickness, non-invasive tear breakup time (NITBUT), corneal and conjunctival staining, conjunctival chalasis, lid wiper epitheliopathy, lagophthalmos, and tear production using Schirmer strip test 1.

Results : 287 subjects (194 females, 93 males) completed the study. Small but statistically significant inter-gender differences were noted in terms of ethnicity, contact lens wear status, NITBUT, TMH, corneal and conjunctival staining, and presence of lagophthalmos. Accounting for these differences, separate multivariate linear mixed effects models found a significant interaction effect between gender and PSQ on the OSDI (p<0.005), SPEED (p=0.01), and VAS related to average daily comfort (p=0.01), end-of-day comfort (p<0.005), average frequency of discomfort (p=0.03) and dryness (p=0.03). The interaction effect suggests that only females had increased dry eye symptoms with greater PSQ score.

Conclusions : The influence of pain sensitivity on dry eye symptoms was found to differ between males and females, where only females had increased symptoms with greater pain sensitivity. The gender difference in how pain sensitivity affects dry eye symptoms may offer insights into why females have a significantly higher dry eye prevalence rate, are more likely to be affected by dry eye, and have a greater likelihood of seeking dry eye treatment than males.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.


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