- Email: [email protected]
Eins, Zwei, Drei – A German's perspective on dry eye numbers in the world
Contact Lens & Anterior Eye 40 (2017) 1–2
Contents lists available at ScienceDirect
Contact Lens & Anterior Eye journal homepage: www.elsevier.com/locate/clae
Guest Editorial
Eins, Zwei, Drei – A German’s perspective on dry eye numbers in the world
Dry eye is a chronic, symptomatic disease of the ocular surface. Worldwide estimates reach 100 million affected people, yet in most cases dry eye remains undiagnosed and therefore untreated. Until recently the traditional concept of dry eye suggested a reduced tear quantity, but this exclusive definition does not suffice any longer. Over the past 50 years the understanding of dry eye has considerably evolved and expanded, and partially reached epidemic levels, especially in the developed countries. Instead, the broader term of keratoconjunctivitis sicca (KCS) has been proposed to include the inflammatory component of the ocular surface, a hint towards the multifactorial nature and diverse aetiology of this condition. Population based studies report dry eye prevalence rates between 5 and 34%, placing it amongst one of the most common eye diseases. When narrowed down to sub-regional populations we see dramatic increases of these numbers, although accurately assessing the epidemiology is a challenge due to risk factors such as age, socio-economic profile of the studied population, as well as the selection criteria of the clinical signs [1,4,6,9,12,14,17]. An Indonesian study included subjects over the age of 21 years and a total of 1058 participants were surveyed on the occurrence of six symptoms; at least one had to be manifest often or constantly [7]. The resulting prevalence was of 27.5%. A Japanese study looked an urban population of 20+ year-olds and identified symptoms in 33%. A more in-depth study in Taiwan considered symptoms and clinical signs in 2038 participants of age 65 and over and from their symptoms alone 33.7% had dry eye [10]. Factoring in a tear break-up times of less than 10 s increased the incidence of dry eye to 78.9%. Whereas, symptoms combined with a pathological Schirmer I test of less than 5 mm gave a result of 62.5% dry eye patients. The Women’s Health Study included 39,876 participants of 49 years and over and found an age-standardized prevalence of 7.8% [13]. The criteria of this study included dryness symptoms and irritation as well as clinical signs. A population-based study out of Salisbury [11] included 2520 patients over the age of 65 years and identified dry eye-related symptoms in 14.6% which increased to 27.4% when factoring in the presence of dry mouth. Delimiting the presence of KCS symptoms and a pathological Schirmer I test of less than 5 mm, resulted in just 2.2%. The combination of symptoms, pathological Schirmer I test and Bengal-Rose colouring over 5 points only affected 0.7% of the study population. The Melbourne Visual Impairment Project studied 926 patients aged 40 years and over, and considered symptoms, the inspection
of the anterior segment, the Jones test, tear break-up time, BengalRose and fluorescein colouring. Photophobia turned out to be the most common dry eye-related symptom. A single patient demonstrated pathological results in all four tests [15]. Pathological Jones, Bengal Rose and tear break-up test results were found in 16.3%, 10.8% and 8.6% of the study population respectively. Studies indicate that contact lens wear is a significant risk factor for the occurrence of dry eye. The German market and user experience research experts GfK found that one in three contact lens wearers showed dry eye symptoms. Moss et al only found this to occur in 15.3% of all German CL wearers [11]. To highlight the importance of the ethno-geographical composition of the study population, in Canada over 51% of CL wearers reported dry eye symptoms [3]. Optometrists in the USA indicated a proportion of 80% of their patients to have dry eye. The question arises why such a low incidence of dry eye has been found in Germany. The answer probably lies in how a study will define dry eye and the methods of population selection [2,5,8,16]. These results highlight the importance of carefully assessing regional populations and the respective risk factors they are exposed to when considering the drastic differences in prevalence. Yet in many countries this common condition is not considered seriously by the eye care practitioners. Patients often remain untreated, which in the case of contact lens wearers usually leads to higher drop-out rates. Medical professionals, ophthalmologists, optometrists and opticians are therefore challenged to raise awareness about this multifactorial condition. The CLAE journal is committed to educate and publish on this relevant topic periodically. This year we will see the DEWS II report being released to the ophthalmic community (Dry Eye WorkShop) and the BCLA biennial congress will have a day of the conference dedicated to dry eye education and research. The BCLA biennial congress will be held in Liverpool 9–11 June 2017 and Friday will play host to the dry eye talks. Amongst the speakers on that day will be the 10 postgraduates from across Europe (Spain, Poland and UK) who are funded by the EDEN project (European Dry Eye Network). The UK partner university is Aston University and Professor James Wolffsohn will be guest editor for a themed issue of CLAE around the topic of dry eye planned for issue 6 of 2017. Authors are invited to submit their original articles for this special issue. On behalf of the CLAE Editorial board we thank all authors, educators, and Eye care specialists for their work in the field of dry eye and furthering our understanding of this common and irritating occurrence.
http://dx.doi.org/10.1016/j.clae.2016.12.005 1367-0484/© 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
2
Guest Editorial / Contact Lens & Anterior Eye 40 (2017) 1–2
References [1] M. Bakkar, W. Shihadeh, M. Haddad, Y. Khader, Epidemiology of symptoms of dry eye disease (DED) in Jordan: a cross-sectional non-clinical populationbased study, Contact Lens Anterior Eye 39 (3) (2016) 197–202. [2] M. Beck, A. Nagel, H. Pult, T. Hofmann, Dry eye tests and treatment: a transnational online survey, Contact Lens Anterior Eye 38 (2015) e27. [3] B. Caffery, D. Richter, T. Simpson, D. Fonn, M. Doughty, K. Gordon, CANDEES, the Canadian dry eye epidemiology study, Adv. Exp. Med. Biol. 438 (1998) 805–806. [4] E.M. Chia, P. Mitchell, E. Rochtchina, A.J. Lee, R. Maroun, J.J. Wang, Prevalence and association of dry eye syndrome in an older population: the Blue Mountains Eye Study, Clin. Exp. Ophthalmol. 31 (2003) 229–232. [5] M. Hillen, The burden of dry eye disease, Ophthalmologist (315) (2015) 1. [6] Y. Jie, L. Xu, Y.Y. Wu, J.B. Jonas, Prevalence of dry eye among adult Chinese in the Beijing Eye Study, Eye 23 (2009) 688–693. [7] A.J. Lee, J. Lee, S.M. Saw, G. Gazzard, D. Koh, D. Widjaja, D.T. Tan, Prevalence and risk factors associated with dry eye symptoms: the population based study in Indonesia, Br. J. Ophthalmol. 86 (2002) 1347–1351. [8] K. Lekhanont, D. Rojanaporn, R.S. Chuck, A. Vongthongsri, Prevalence of dry eye in Bangkok, Thailand, Cornea 25 (2006) 1162–1167. [9] M.A. Lemp, K.K. Nichols, Blepharitis in the Unites States 2009: a survey-based perspective on prevalence and treatment, Ocul. Surf. 7 (2009) S1–S14. [10] P.Y. Lin, S.Y. Tsai, C.Y. Cheng, J.H. Liu, P. Chou, W.M. Hsu, Prevalence of dry eye among an elderly Chinese population in Taiwan, Ophthalmology 110 (2003) 1096–1101. [11] S.E. Moss, R. Klein, B.E. Klein, Incidence of dry eye in an older population, Arch. Ophthalmol. 122 (2004) 369–373.
[12] S. Olaniyan, O. Fasina, C. Bekibele, A. Ogundipe, Dry eye disease in an adult population in South-West Nigeria, Contact Lens Anterior Eye 39 (5) (2016) 359–364. [13] D.A. Schaumberg, D.A. Sullivan, J.E. Buring, M.R. Dana, Prevalence of dry eye syndrome among US women, Am. J. Ophthalmol. 16 (2003) 318–326. [14] J.A. Smith, J. Albeitz, C. Begley, B. Caffery, K.K. Nichols, D.A. Schaumberg, O. Schein, The epidemiology of dry eye disease: report of the epidemiology subcommittee of the international dry eye workshop, Ocul. Surf. 5 (2007) 93–107. [15] S. Fiona, Q. Garrett, C. Chan, J.P. Craig, The epidemiology of dry eye disease, Essentials in Ophthalmology, 2015. [16] M. van Tilborg, P. Murphy, K. Evans, Agreement in dry eye management between optometrists and general practitioners in primary health care in the Netherlands, Contact Lens Anterior Eye 38 (4) (2014) 283–293. [17] P. Versura, M. Cellini, A. Torregiani, V. Profazio, B. Bernabini, R. Caramazza, Dryness symptoms, diagnostic protocol and therapeutic management: a report of 1,200 patients, Ophthalmic Res. 33 (2001) 221–227.
Prof. Wolfgang Sickenberger (MSc Optom., Dipl. Ing. (FH) AO) a,b,c,d a Editorial Panel Member CLAE Journal b Head Course of Optometry and Vision Science c Director, JenVis Research Institute d Ernst Abbe University Jena, Carl Zeiss Promenade 1, 07745 Jena, Germany E-mail address: [email protected]
Contents lists available at ScienceDirect
Contact Lens & Anterior Eye journal homepage: www.elsevier.com/locate/clae
Guest Editorial
Eins, Zwei, Drei – A German’s perspective on dry eye numbers in the world
Dry eye is a chronic, symptomatic disease of the ocular surface. Worldwide estimates reach 100 million affected people, yet in most cases dry eye remains undiagnosed and therefore untreated. Until recently the traditional concept of dry eye suggested a reduced tear quantity, but this exclusive definition does not suffice any longer. Over the past 50 years the understanding of dry eye has considerably evolved and expanded, and partially reached epidemic levels, especially in the developed countries. Instead, the broader term of keratoconjunctivitis sicca (KCS) has been proposed to include the inflammatory component of the ocular surface, a hint towards the multifactorial nature and diverse aetiology of this condition. Population based studies report dry eye prevalence rates between 5 and 34%, placing it amongst one of the most common eye diseases. When narrowed down to sub-regional populations we see dramatic increases of these numbers, although accurately assessing the epidemiology is a challenge due to risk factors such as age, socio-economic profile of the studied population, as well as the selection criteria of the clinical signs [1,4,6,9,12,14,17]. An Indonesian study included subjects over the age of 21 years and a total of 1058 participants were surveyed on the occurrence of six symptoms; at least one had to be manifest often or constantly [7]. The resulting prevalence was of 27.5%. A Japanese study looked an urban population of 20+ year-olds and identified symptoms in 33%. A more in-depth study in Taiwan considered symptoms and clinical signs in 2038 participants of age 65 and over and from their symptoms alone 33.7% had dry eye [10]. Factoring in a tear break-up times of less than 10 s increased the incidence of dry eye to 78.9%. Whereas, symptoms combined with a pathological Schirmer I test of less than 5 mm gave a result of 62.5% dry eye patients. The Women’s Health Study included 39,876 participants of 49 years and over and found an age-standardized prevalence of 7.8% [13]. The criteria of this study included dryness symptoms and irritation as well as clinical signs. A population-based study out of Salisbury [11] included 2520 patients over the age of 65 years and identified dry eye-related symptoms in 14.6% which increased to 27.4% when factoring in the presence of dry mouth. Delimiting the presence of KCS symptoms and a pathological Schirmer I test of less than 5 mm, resulted in just 2.2%. The combination of symptoms, pathological Schirmer I test and Bengal-Rose colouring over 5 points only affected 0.7% of the study population. The Melbourne Visual Impairment Project studied 926 patients aged 40 years and over, and considered symptoms, the inspection
of the anterior segment, the Jones test, tear break-up time, BengalRose and fluorescein colouring. Photophobia turned out to be the most common dry eye-related symptom. A single patient demonstrated pathological results in all four tests [15]. Pathological Jones, Bengal Rose and tear break-up test results were found in 16.3%, 10.8% and 8.6% of the study population respectively. Studies indicate that contact lens wear is a significant risk factor for the occurrence of dry eye. The German market and user experience research experts GfK found that one in three contact lens wearers showed dry eye symptoms. Moss et al only found this to occur in 15.3% of all German CL wearers [11]. To highlight the importance of the ethno-geographical composition of the study population, in Canada over 51% of CL wearers reported dry eye symptoms [3]. Optometrists in the USA indicated a proportion of 80% of their patients to have dry eye. The question arises why such a low incidence of dry eye has been found in Germany. The answer probably lies in how a study will define dry eye and the methods of population selection [2,5,8,16]. These results highlight the importance of carefully assessing regional populations and the respective risk factors they are exposed to when considering the drastic differences in prevalence. Yet in many countries this common condition is not considered seriously by the eye care practitioners. Patients often remain untreated, which in the case of contact lens wearers usually leads to higher drop-out rates. Medical professionals, ophthalmologists, optometrists and opticians are therefore challenged to raise awareness about this multifactorial condition. The CLAE journal is committed to educate and publish on this relevant topic periodically. This year we will see the DEWS II report being released to the ophthalmic community (Dry Eye WorkShop) and the BCLA biennial congress will have a day of the conference dedicated to dry eye education and research. The BCLA biennial congress will be held in Liverpool 9–11 June 2017 and Friday will play host to the dry eye talks. Amongst the speakers on that day will be the 10 postgraduates from across Europe (Spain, Poland and UK) who are funded by the EDEN project (European Dry Eye Network). The UK partner university is Aston University and Professor James Wolffsohn will be guest editor for a themed issue of CLAE around the topic of dry eye planned for issue 6 of 2017. Authors are invited to submit their original articles for this special issue. On behalf of the CLAE Editorial board we thank all authors, educators, and Eye care specialists for their work in the field of dry eye and furthering our understanding of this common and irritating occurrence.
http://dx.doi.org/10.1016/j.clae.2016.12.005 1367-0484/© 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
2
Guest Editorial / Contact Lens & Anterior Eye 40 (2017) 1–2
References [1] M. Bakkar, W. Shihadeh, M. Haddad, Y. Khader, Epidemiology of symptoms of dry eye disease (DED) in Jordan: a cross-sectional non-clinical populationbased study, Contact Lens Anterior Eye 39 (3) (2016) 197–202. [2] M. Beck, A. Nagel, H. Pult, T. Hofmann, Dry eye tests and treatment: a transnational online survey, Contact Lens Anterior Eye 38 (2015) e27. [3] B. Caffery, D. Richter, T. Simpson, D. Fonn, M. Doughty, K. Gordon, CANDEES, the Canadian dry eye epidemiology study, Adv. Exp. Med. Biol. 438 (1998) 805–806. [4] E.M. Chia, P. Mitchell, E. Rochtchina, A.J. Lee, R. Maroun, J.J. Wang, Prevalence and association of dry eye syndrome in an older population: the Blue Mountains Eye Study, Clin. Exp. Ophthalmol. 31 (2003) 229–232. [5] M. Hillen, The burden of dry eye disease, Ophthalmologist (315) (2015) 1. [6] Y. Jie, L. Xu, Y.Y. Wu, J.B. Jonas, Prevalence of dry eye among adult Chinese in the Beijing Eye Study, Eye 23 (2009) 688–693. [7] A.J. Lee, J. Lee, S.M. Saw, G. Gazzard, D. Koh, D. Widjaja, D.T. Tan, Prevalence and risk factors associated with dry eye symptoms: the population based study in Indonesia, Br. J. Ophthalmol. 86 (2002) 1347–1351. [8] K. Lekhanont, D. Rojanaporn, R.S. Chuck, A. Vongthongsri, Prevalence of dry eye in Bangkok, Thailand, Cornea 25 (2006) 1162–1167. [9] M.A. Lemp, K.K. Nichols, Blepharitis in the Unites States 2009: a survey-based perspective on prevalence and treatment, Ocul. Surf. 7 (2009) S1–S14. [10] P.Y. Lin, S.Y. Tsai, C.Y. Cheng, J.H. Liu, P. Chou, W.M. Hsu, Prevalence of dry eye among an elderly Chinese population in Taiwan, Ophthalmology 110 (2003) 1096–1101. [11] S.E. Moss, R. Klein, B.E. Klein, Incidence of dry eye in an older population, Arch. Ophthalmol. 122 (2004) 369–373.
[12] S. Olaniyan, O. Fasina, C. Bekibele, A. Ogundipe, Dry eye disease in an adult population in South-West Nigeria, Contact Lens Anterior Eye 39 (5) (2016) 359–364. [13] D.A. Schaumberg, D.A. Sullivan, J.E. Buring, M.R. Dana, Prevalence of dry eye syndrome among US women, Am. J. Ophthalmol. 16 (2003) 318–326. [14] J.A. Smith, J. Albeitz, C. Begley, B. Caffery, K.K. Nichols, D.A. Schaumberg, O. Schein, The epidemiology of dry eye disease: report of the epidemiology subcommittee of the international dry eye workshop, Ocul. Surf. 5 (2007) 93–107. [15] S. Fiona, Q. Garrett, C. Chan, J.P. Craig, The epidemiology of dry eye disease, Essentials in Ophthalmology, 2015. [16] M. van Tilborg, P. Murphy, K. Evans, Agreement in dry eye management between optometrists and general practitioners in primary health care in the Netherlands, Contact Lens Anterior Eye 38 (4) (2014) 283–293. [17] P. Versura, M. Cellini, A. Torregiani, V. Profazio, B. Bernabini, R. Caramazza, Dryness symptoms, diagnostic protocol and therapeutic management: a report of 1,200 patients, Ophthalmic Res. 33 (2001) 221–227.
Prof. Wolfgang Sickenberger (MSc Optom., Dipl. Ing. (FH) AO) a,b,c,d a Editorial Panel Member CLAE Journal b Head Course of Optometry and Vision Science c Director, JenVis Research Institute d Ernst Abbe University Jena, Carl Zeiss Promenade 1, 07745 Jena, Germany E-mail address: [email protected]