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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 3  |  Page : 140-144

Prevalence of dry eye symptoms and its risk factors among patients of King Abdulaziz Specialist Hospital (Taif), Saudi Arabia


1 College of Medicine, Taif University, Taif, Saudi Arabia
2 College of Pharmacy, Taif University, Taif, Saudi Arabia

Date of Web Publication6-Feb-2018

Correspondence Address:
Dr. Abdulrahman Ahmad Alzahrani
College of Medicine, Taif University, Taif
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_90_17

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  Abstract 

Background: The prevalence of dry eye symptoms is estimated to be between 7% and 34% depending on the studies, the diagnostic tests used, or the populations studied. Eye dryness is caused primarily by an aqueous deficiency, excessive lacrimal film evaporation or a combination of both. Besides age, several individual and environmental causes were reported as risk factors of dry eye symptoms. Purpose: The objectives of this study were to assess the prevalence of dry eye symptoms and to determine the most frequent risk factors among patients of King Abdul-Aziz Specialist Hospital (Taif), Saudi Arabia. Methods: An observational cross-sectional study using a valid questionnaire (ocular surface disease index [OSDI]) was used to assess the symptoms of dry eye among patients at King Abdulaziz Specialist Hospital in Taif city from August to September 2017. Statistical data were analyzed using Statistical package for the social sciences version 21.0. Results: Out of 482 patients (mean age = 50.16), 116 patients were normal (0≤ OSDI Score ≤12), 103 patients had mild dry eye (13≤ OSDI Score ≤22), moderate dry eye (23≤ OSDI Score ≤32) was prevalent among 62 patients and 201 patients had severe dry eyes (OSDI Score ≤33). No significant effect of gender (P = 0.71) was observed on symptoms of dry. However, age has significant but weak impact (P = 0.01, r = 0.155). Arthritis (P = 0.021, odds ratio [OR] =1.95%; 95% confidence interval [CI]: 1.1, 3.43) and hypercholesterolemia (OR = 2.24, 95% CI: 1.36, 3.69, P = 0.002) were significant factors for dry eye condition. Conclusion: The dry eye symptoms are highly prevalent among patients of King Abdulaziz Hospital. A lot of factors show no significant difference such as smoking and diabetes between groups exposed and not exposed while others such as arthritis and hypercholesterolemia show statistically significant difference. We must make more effort to know what exactly related to dry eye for early intervention and management.

Keywords: Dry eye, prevalence, risk factors, Saudi Arabia


How to cite this article:
Alhamyani AH, Noor Kalakattawi RM, Noor Kalakattawi AM, Alhamyani AH, Alsuqati FA, Al-Shehri LA, Assery MS, Alzahrani AA. Prevalence of dry eye symptoms and its risk factors among patients of King Abdulaziz Specialist Hospital (Taif), Saudi Arabia. Saudi J Health Sci 2017;6:140-4

How to cite this URL:
Alhamyani AH, Noor Kalakattawi RM, Noor Kalakattawi AM, Alhamyani AH, Alsuqati FA, Al-Shehri LA, Assery MS, Alzahrani AA. Prevalence of dry eye symptoms and its risk factors among patients of King Abdulaziz Specialist Hospital (Taif), Saudi Arabia. Saudi J Health Sci [serial online] 2017 [cited 2018 Oct 21];6:140-4. Available from: http://www.saudijhealthsci.org/text.asp?2017/6/3/140/224751


  Introduction Top


The International Dry Eye Workshop defines ocular dryness as a multifactorial disease of tears and ocular surface that causes symptoms of discomfort, visual disturbance, and instability of the tear film with potential lesions of the ocular surface. It is accompanied by an increase in the osmolarity of the tear film and an inflammation of the ocular surface.[1]

With the refinement of the definition of dry eye through the last decades, researchers have become more and more interested in studying it. Hence, dry eye is not any more decayed within the framework of Sjögren syndrome but considered as a separate pathological entity.[2] The prevalence of dry eye symptoms is estimated to be between 7% and 34% depending on the studies, the diagnostic tests used, or the populations studied.[3],[4],[5],[6]

Eye dryness is primarily caused by an aqueous deficiency, excessive lacrimal film evaporation, or a combination of both. When the lacrimal gland function is adversely affected, it consequently decreases tear volume, leading to aqueous deficiency. In evaporative dryness, the tear volume is normal; however, the tear film is abnormal due to rapid evaporation. Up to 86% of patients with dry eye symptoms would be affected by the evaporative form.[7],[8] About 14% of persons above the age of 65 report symptoms of dry eye.[9] Besides age, several individual and environmental causes were reported as risk factors of dry eye as being a female, smoking, depression, or undergoing a laser in situ keratomileusis (LASIK) operation.[4],[10],[11],[12]

Studies conducted in Saudi Arabia (Riyadh, Jeddah, and Al-Ahsa) reported that these symptoms were prevalent and associated with chronic diseases.[13],[14],[15] The objectives of this study were to assess the prevalence of dry eye symptoms among Taif population, Saudi Arabia and to determine the most frequent risk factors of the disease.


  Methods Top


An observational cross-sectional study using a questionnaire was performed to respond the purpose of this study. The questionnaires were distributed to patients at King Abdulaziz specialist hospital in Taif city, Saudi Arabia, from August to September 2017. At the end of the survey, 482 complete questionnaires were collected. A valid questionnaire, ocular surface disease index (OSDI), was used to assess the dry eye symptoms. The OSDI is assessed on a scale of 0–100, with higher scores representing greater disability. The sensitivity and specificity are demonstrated through the index, which distinguishes the normal participants and dry eye disease (DED) patients. This score includes 3 ocular symptom questions, 6 vision-related function questions, and 3 environmental trigger questions. Each question score ranges from 0 (“none of the time”) to 4 (“all of the time”). The total score is calculated based on the following formula:[16]



Frequencies were used to describe qualitative variables while mean and standard deviation (SD) are used to describe quantitative variables. To assess the difference of OSDI score between different groups, student t- test was performed. Data analysis was performed using SPSS version 21.0 (IBM Corp, 2012).


  Results Top


Four hundred and eighty-two patients participated in this study. About 64.1% of the participants were females and 35.9% were males. The mean age of the participants was 50.16 years (SD ± 16.8) [Table 1]. The frequency of factors was 12.7% for smoking (61 cases), 26.1% for arthritis (126 cases), 95.9% for diabetes (462 cases), 15.4% for thyroid diseases (74 cases), 42.5% for hypercholesterolemia (205 cases), 49.6% for aspirin use, 63.7% for multivitamin usage (307 cases), and 90.7% for drinking caffeine (437 cases) [Table 1].
Table 1: Demographic characteristics and risk factors distribution among participants in ocular surface disease index questionnaire (n=482)

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The mean of OSDI score was 30.5 (SD ± 22.9) [Figure 1]. The normal participants were 116 (24.1%), and they achieved OSDI score between 0 and 12. Those who scored from 13 to 22 were considered to have mild dry eye, and their number was 103 (21.4%) while score from 23 to 32 was considered moderate dry eye, and the number of patients of this group was 62 (12.9%). Participants who scored 33 or more were considered to have severe dry eye, and their number was 201 representing 41.7% of all participants of this study [Table 2]. OSDI score was compared between male and female participants, the mean for males was 31.3 (SD ± 22.1), and for the females, it was 30.1(SD ± 23.3). There was no significant difference in the score between genders (P = 0.71).
Figure 1: Ocular surface disease index score of different sections (n = 482)

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Table 2: The prevalence of mild, moderate, and severe dry eye test (n=482)

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With regard to the following risk factors: smoking, diabetes, thyroid diseases, antidepressants, multivitamin, caffeine drinking, and contact lens usage, no significant difference was observed between the group exposed to the factors and the group without exposure [Table 3]. The difference in OSDI was significant regarding arthritis (P ≤ 0.05). The patients with arthritis had a higher score, mean score was 37.4 (SD ± 23.8), compared with patients without arthritis who had an average score of 28.1 (SD ± 22.1).
Table 3: Comparing ocular surface disease index score between participants who have particular factor and those who do not have, using student's t-test (n=482)

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It was also statistically significant regarding in hypercholesterolemia (P ≤ 0.05), patients with hypercholesterolemia had a higher score, mean score was 36.8 (SD ± 24), than those without hypercholesterolemia, whose mean score was 25.9 (SD ± 20.9). A statistical significance also observed regarding aspirin use (P ≤ 0.05), patients using aspirin had a higher score, mean score is 34.4 (SD ± 23.3) than those who did not use aspirin, mean score was 26.7 (SD ± 21.9). Furthermore, patients with LASIK operation had a mean score significantly higher than patients who did not have the LASIK operation, mean score was 42.5 (SD ± 27) for the first group and 29.3 (SD ± 22.1) for the second group (P ≤ 0.05).

The correlation of score of OSDI and age of participants was studied using Pearson correlation coefficient, and a positive weak relationship between the two variables with P = 0.01 and a correlation coefficient of 0.155 was found.Significance of the association between factors and dry eye symptoms (OSDI score higher than 12) was established by the logistic regression analysis [Table 4]. The significant factors in the model were arthritis (P = 0.021) and the odds ratio (OR) =1.95 (95% confidence interval [CI]: 1.1, 3.43) and the hypercholesterolemia (P = 0.002) and the OR = 2.24 (95% CI: 1.36, 3.69). The factors which did not have any significant relationships are mentioned in [Table 4].
Table 4: Logistic regression analysis to establish association between risk factors and dry eye symptoms

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Logistic regression is done to test for the different factors and the presence of dry eye symptoms (OSDI score higher than 12). The significant factors in the model were arthritis (P = 0.021) and OR = 1.95 (95% CI: 1.1, 3.43) and hypercholesterolemia (P = 0.002) and OR = 2.24 (95% CI: 1.36, 3.69).


  Discussion Top


A cross-sectional study was conducted at King Abdulaziz hospital in Taif using a valid questionnaire (OSDI) which is a scale from 0 to 100; the higher the value, the more severe the dryness. Four hundred and eighty-five patients participated in this study; 64.1% of them were females.

A higher ODSI score is associated with a higher incidence of dry eye; this was the case in the groups with arthritis and hypercholesterolemia in the patients using aspirin and in the patients who underwent LASIK operation.

There was a significantly weak correlation between OSDI score and age; however, no significant difference in the score between males and females was observed. Further, there was no statistically significant difference in OSDI between the group that was exposed to the factors (smoking, diabetes, thyroid diseases, antidepressants, multivitamin use, caffeine drinking, and contact lens usage) and the group who did not.

Similar, to our study, a population-based cohort study conducted by Moss found that arthritis and hypercholesterolemia were significantly associated with dry eye while the use of antidepressant was not.[4] However, there are discrepancies between the two studies. Moss found that smoking, caffeine use, history of thyroid disease, diabetes, and multivitamin use were significantly associated with dry eye which is contrary to our study. Many previous studies found that dry eye syndrome is higher in females than in males.[17],[18],[19] A study based on questionnaire and dry eye testing conducted by Uchino et al. In Japan, the prevalence of dry eye was found higher in women (OR = 2.00; P = 0.002),[18] and similar to our study, smoking was not considered as a risk factor. Yet, our study did not report any gender-based biasness in dry eyes symptoms. Prospective-based study was carried out among 251 people of Jeddah, Saudi Arabia. Based on interview and dry eye symptoms, the factors associated with dry eyes were established. No significant association with gender and age was found. Notably, smoking was second critical factor for dry eye.[13] The effect of gender was similar to our study whereas, in case of age, it was not similar to our study. However, our study did not find any significant association between smoking and dry eye symptoms [Table 4].

Age, thyroid disease, and the use of antidepressant was found to be responsible for increasing the risk of dry eye syndrome.[11],[17] Previously, Shua Azam et al. reviewed that the number of cases with dry eye syndrome increased significantly with age in women and in patients with systemic diseases (diabetes mellitus and hypertension).[20] Equally, in a case–control study based on standard ophthalmologic examinations, Yang et al. reported diabetes and the use of antidepressants as considerable risk factors of dry eye syndrome.[21] A study based on OSDI score conducted by Yun et al. reported that the use of contacts lens was also associated with high OSDI score (P < 0.01).[22] A case series was carried out at a tertiary hospital of Riyadh, Saudi Arabia, among 62 patients to find the level of diabetes and hypertension among patients suffering from dry eye symptoms. This study reported that chronic diseases such as diabetes, hypertension, obesity, and dyslipidemia were more prevalent among patients of dry eye syndrome as compared to normal population.[14] However, our studies only find arthritis (P = 0.021, OR = 1.95; 95% CI: 1.1, 3.43), and the hypercholesterolemia (P = 0.002) and the OR = 2.24, 95% CI: 1.36, 3.69) as a significant association to dry eye symptoms [Table 4].

A multistage proportionate study was conducted among urban and rural population (1858 adults, mean age of 39.3 ± 14.1 years) of Al-Ahsa, Saudi Arabia. Multivariate logistic regression analysis of data showed that dry eye symptoms were more prevalent among female and older patients. Smoking and diabetes mellitus were significantly associated with dry eye symptoms and arthritis did not have any effect on dry eye conditions.[15] However, our study did not find any association of smoking and diabetes to the dry eye symptoms, and it also find significant impact between arthritis and dry eye symptoms. In this study, other factors such as use of contact lens, caffeine drinking, multivitamin supplement, and thyroid disease did not have any association with dry eye symptoms which is in agreement with our study [Table 4].

Another similar study by Yun et al. determined the prevalence of DED and factors among young people based on the OSDI questionnaire.[22] They concluded that a high OSDI score was associated with female sex, a history of allergic conjunctivitis, and contact lens use. These different results may be attributed to different study designs, sample sizes, regional variations, and genetic traits.


  Conclusion Top


Conclusively, dry eye symptoms is a strongly associated with arthritis, hypercholesterolemia, aspirin use, and patients who had LASIK operation. No significant difference between the group exposed and the group without exposure to the following factors: smoking, diabetes, thyroid diseases, antidepressants, multivitamin, caffeine drinking, and contact lens usage. Among participants, 116 (24.07%) were normal. Patients with mild symptoms were 103 (21.37%). Patients with moderate symptoms were 62 (12.86%) while patients with severe symptoms were 201 (41.70%). Because of its significant impact on the quality of life of those patients, we should multiply our efforts in researches, screening, and examination to know what exactly related to dry eye symptoms for early intervention and management.

Acknowledgment

We would like to extend special acknowledgment to the following Medical Students in College of Medicine, Taif University, Saudi Arabia: Shrooq Hadi Mujurdy, Mai Muaiwedh Algethami, and Reemah Ahmad AlSumairi, for their valuable efforts and active role in data collection phase.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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