Diagnostic Methodology and Epidemiology of Dry Eye Disease

Abstract

Background: Dry eye disease is a highly prevalent ophthalmic condition with profound impacts on ocular comfort, visual function, and quality of life. The aims of this doctoral thesis were to examine two significant gaps in the contemporaneous literature, consistent with those identified by the recent global consensus Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II), including the evaluation of the diagnostic performance of clinical tests for dry eye disease, and the investigation of modifiable and non-modifiable risk factors of the condition. Methods: This doctoral thesis was based primarily on two population-based observational studies. The Auckland Dry Eye Epidemiology Study is a multi-arm, prospective registry, crosssectional study of 2529 community residents from the Auckland region. The Dry Eye Substudy of the Dunedin Multidisciplinary Health and Developmental Study assessed a population-representative birth cohort of 885 participants followed up at 45 years of age. In both studies, dry eye symptomology, ocular surface characteristics, and tear film parameters of participants were evaluated within a single clinical session. Results: Individual clinical tests, including validated symptomology questionnaires, tear film stability, osmolarity measurements, ocular surface staining, and meibomian gland dysfunction markers, demonstrated modest to moderate diagnostic accuracy for detecting dry eye disease as defined by the global consensus TFOS DEWS II criteria. A non-invasive rapid screening algorithm was developed and exhibited high diagnostic agreement with the TFOS DEWS II criteria. A number of risk factors for dry eye disease were highlighted, including advancing age, female sex, Asian ethnicity, incomplete blinking, systemic rheumatologic disease, xerostomia, migraine headaches, thyroid disease, antidepressant medication, oral contraceptive therapy, digital device screen exposure time, and eye cosmetics. Caffeine consumption was identified to be a protective factor. Dry eye disease was associated with poorer self-perceived health status and increased psychological stress burden. Conclusions: The findings of the diagnostic accuracies studies of this doctoral thesis largely support the recommendations made by the TFOS DEWS II reports. The identification of modifiable and non-modifiable risk factors in the epidemiology studies might contribute to the design of future research investigating population screening, risk factor modification, and preventative intervention strategies for dry eye disease.