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Jennifer P Craig, Michael TM Wang; Factors predisposing the Asian eye to dry eye disease. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2746.
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© ARVO (1962-2015); The Authors (2016-present)
Asian ethnicity is a mostly consistent risk factor for dry eye disease (DED) according to TFOS DEWS II. However, differences in climate, environment and lifestyle, as well as in diagnostic criteria and methodology across different continents, limit direct inter-ethnic comparison of study outcomes and reported prevalence rates. This series of studies sought to compare DED prevalence, across a range of ages, in co-located Asian and Caucasian cohorts.
Age, sex, environment and lifestyle matched individuals of South East Asian or Caucasian descent (n=350), divided into pediatric (5 -17 years), young adult (18-25 years), middle adult (25 – 45 years) and older adult (over 46 years) and who were NZ born and raised (pediatric and young adult), or resident for a minimum of 15 years in NZ (middle and older adults), underwent DED screening that included evaluation of symptoms (OSDI), tear film, meibomian glands, ocular surface, blinking and dry eye prevalence. Effects of age and ethnicity on DED prevalence and development were assessed.
While DED prevalence and meibomian gland dropout rates in the pediatric group did not differ significantly between ethnic groups (p>0.05), significantly greater blink incompleteness and lid wiper epitheliopathy were observed in the Asian group. These findings persisted throughout life, compounded by increasing inter-ethnic disparities in ocular surface health reflected in higher meibomian gland drop out in the Asian young adult group, and more marked loss of tear film homeostasis, as well as symptoms, in the middle and older adult groups (all p<0.05). Dry eye prevalence showed increasing disparity between ethnic groups with advancing age.
Consistent with the literature, DED prevalence increased in both ethnic groups with age. A predisposition to DED was noted in the co-located, environment and lifestyle-matched Asian cohort. The earliest inter-ethnic disparity in incomplete blink closure, believed to be associated with increased eyelid tension in the Asian eye, is hypothesized to predispose the eye to poorer meibomian gland health with advancing age, leading to poorer tear film and ocular surface health, and patient-reported symptoms. Alignment of the observed changes with tear quality rather than tear quantity implicates hyperevaporation, secondary to loss of meibomian gland function, over aqueous deficiency in the natural history of DED development.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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