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Case finding of dry eye disease in Norwegian optometric practice: a cross-sectional study

Authors

DOI:

https://doi.org/10.5384/sjovs.v14i1.131

Keywords:

dry eye disease, ocular surface disease index, meibomian gland dysfunction, tear breakup time, ocular staining

Abstract

Optometrists are primary eye care providers, and it is essential that they efficiently identify patients who will benefit from dry eye management. The aim of the study was to explore case finding of dry eye disease (DED) in optometric practice. A cross-sectional study examining dry eye symptoms and signs in 186 patients (18–70 years of age) attending a routine eye examination, with DED defined according to the criteria of the Tear Film and Ocular Surface Society Dry Eye Workshop II. Standard statistical tests were used, and clinical diagnostics were explored using sensitivity, specificity, and receiveroperating curve (ROC) statistics. Fifty-six patients were contact lens wearers, and they were significantly younger than the non-contact lens wearers (mean age 35 (SD = 1) versus 48 (± 2) years). The mean best corrected visual acuity (BCVA) in the better eye was 1.0 (± 0.1) (decimal acuity). There was no difference in BCVA between contact lens wearers and non-contact lens wearers. The mean Ocular Surface Disease Index (OSDI) score was 22 (± 19), and 138 patients had at least one positive homeostasis marker. Eighty-six had DED, 52 had signs without symptoms, and 23 had symptoms without signs of DED. The sensitivity and specificity of OSDI in detecting any positive homeostasis marker were 62% and 54%, respectively. In all, 106 patients had meibomian gland dysfunction (MGD), of which 49 were asymptomatic. In a ROC analysis, an OSDI ≥ 13 showed a diagnostic ability to differentiate between patients with a fluorescein breakup time (FBUT) < 10 seconds and a fluorescein breakup time ≥ 10 seconds, but not between patients with and without staining or MGD. The majority of patients had dry eye signs and/or dry eye symptoms. Routine assessment of FBUT and meibomian glands may enable case finding of DED in optometric practice.

References

Arita, R., Mizoguchi, T., Kawashima, M., Fukuoka, S., Koh, S., Shirakawa, R., Suzuki, T., & Morishige, N. (2019). Meibomian gland dysfunction and dry eye are similar but different based on a population-based study: The Hirado-Takushima Study in Japan. American Journal of Ophthalmology, 207, 410–418. https://doi.org/10.1016/j.ajo.2019.02.024

Bartlett, J. D., Keith, M. S., Sudharshan, L., & Snedecor, S. J. (2015). Associations between signs and symptoms of dry eye disease: A systematic review. Clinical Ophthalmology, 9, 1719–30. https://doi.org/10.2147/opth.S89700

Blackie, C. A., Korb, D. R., Knop, E., Bedi, R., Knop, N., & Holland, E. J. (2010). Nonobvious obstructive meibomian gland dysfunction. Cornea, 29(12), 1333–45. https://doi.org/10.1097/ICO.0b013e3181d4f366

Bron, A. J., Evans, V. E., & Smith, J. A. (2003). Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea, 22(7), 640–50. https://doi.org/10.1097/00003226-200310000-00008

Craig, J. P., Nichols, K. K., Akpek, E. K., Caffery, B., Dua, H. S., Joo, C. K., Liu, Z., Nelson, J. D., Nichols, J. J., Tsubota, K., & Stapleton, F. (2017). TFOS DEWS II Definition and classification report. The Ocular Surface, 15(3), 276–283. https:

//doi.org/10.1016/j.jtos.2017.05.008

Downie, L. E., Keller, P. R., & Vingrys, A. J. (2013). An evidence-based analysis of Australian optometrists’ dry eye practices. Optometry and Vision Science, 90(12), 1385–95. https://doi.org/10.1097/opx.0000000000000087

Downie, L. E., Rumney, N., Gad, A., Keller, P. R., Purslow, C., & Vingrys, A. J. (2016). Comparing self-reported optometric dry eye clinical practices in Australia and the United Kingdom: Is there scope for practice improvement? Ophthalmic & Physiological Optics, 36(2), 140–51. https://doi.org/10.1111/opo.12280

Farrand, K. F., Fridman, M., Stillman, I. Ö., & Schaumberg, D. A. (2017). Prevalence of diagnosed dry eye disease in the United States among adults aged 18 years and older. American Journal of Ophthalmology, 182, 90–98. https://doi.org/

https://doi.org/10.1016/j.ajo.2017.06.033

Geerling, G., Tauber, J., Baudouin, C., Goto, E., Matsumoto, Y., O’Brien, T., Rolando, M., Tsubota, K., & Nichols, K. K. (2011). The international workshop on meibomian gland dysfunction: Report of the subcommittee on management and treatment of meibomian gland dysfunction. Investigative Ophthalmology & Visual Science, 52(4), 2050–64. https://doi.org/10.1167/iovs.10-6997g

Green-Church, K. B., Butovich, I., Willcox, M., Borchman, D., Paulsen, F., Barabino, S., & Glasgow, B. J. (2011). The international workshop on meibomian gland dysfunction: Report of the subcommittee on tear film lipids and lipid-protein interactions in health and disease. Investigative Ophthalmology & Visual Science, 52(4), 1979–93. https://doi.org/10.1167/iovs.10-6997d

Hashemi, H., Khabazkhoob, M., Kheirkhah, A., Emamian, M. H., Mehravaran, S., Shariati, M., & Fotouhi, A. (2014). Prevalence of dry eye syndrome in an adult population. Clinical and Experimental Ophthalmology, 42(3), 242–8. https://doi.

org/10.1111/ceo.12183

Herbaut, A., Liang, H., Denoyer, A., Baudouin, C., & Labbé, A. (2019). Tear film analysis and evaluation of optical quality: A review of the literature. Journal Français d’Ophtalmologie, 42(2), e21–e35. https://doi.org/https://doi.org/10.1016/ j.jfo.2018.12.001

Ishida, R., Kojima, T., Dogru, M., Kaido, M., Matsumoto, Y., Tanaka, M., Goto, E., & Tsubota, K. (2005). The application of a new continuous functional visual acuity measurement system in dry eye syndromes. American Journal of Ophthalmology,

(2), 253–8. https://doi.org/10.1016/j.ajo.2004.08.075

Jones, L., Downie, L. E., Korb, D., Benitez-Del-Castillo, J. M., Dana, R., Deng, S. X., Dong, P. N., Geerling, G., Hida, R. Y., Liu, Y., Seo, K. Y., Tauber, J., Wakamatsu, T. H., Xu, J., Wolffsohn, J. S., & Craig, J. P. (2017). TFOS DEWS II Management and therapy report. The Ocular Surface, 15(3), 575–628. https://doi.org/10.1016/j.jtos.2017.05.006

Kim, M. J., Stinnett, S. S., & Gupta, P. K. (2017). Effect of thermal pulsation treatment on tear film parameters in dry eye disease patients. Clinical Ophthalmology, 11, 883–886. https://doi.org/10.2147/opth.S136203

Koh, S. (2018). Irregular astigmatism and higher-order aberrations in eyes with dry eye disease. Investigative Ophthalmology & Visual Science, 59(14), DES36–DES40. https://doi.org/10.1167/iovs.17-23500

Lee, H., Kim, M., Park, S. Y., Kim, E. K., Seo, K. Y., & Kim, T. I. (2017). Mechanical meibomian gland squeezing combined with eyelid scrubs and warm compresses for the treatment of meibomian gland dysfunction. Clinical and Experimental Optometry, 100(6), 598–602. https://doi.org/10.1111/cxo.12532

Li, M., Gong, L., Chapin, W. J., & Zhu, M. (2012). Assessment of vision-related quality of life in dry eye patients. Investigative Ophthalmology & Visual Science, 53(9), 5722–7. https://doi.org/10.1167/iovs.11-9094

Malet, F., Le Goff, M., Colin, J., Schweitzer, C., Delyfer, M.-N., Korobelnik, J.-F., Rougier, M.-B., Radeau, T., Dartigues, J.-F., & Delcourt, C. (2014). Dry eye disease in French elderly subjects: The Alienor Study. Acta Ophthalmologica, 92(6), e429–e436. https://doi.org/10.1111/aos.12174

McMonnies, C. W. (2018). Tear instability importance, mechanisms, validity and reliability of assessment. Journal of Optometry, 11(4), 203–210. https://doi.org/10.1016/j.optom.2017.11.004

Millar, T. J., & Schuett, B. S. (2015). The real reason for having a meibomian lipid layer covering the outer surface of the tear film – a review. Experimental Eye Research, 137, 125–138. https://doi.org/https://doi.org/10.1016/j.exer.2015.05.002

Miller, K. L., Walt, J. G., Mink, D. R., Satram-Hoang, S., Wilson, S. E., Perry, H. D., Asbell, P. A., & Pflugfelder, S. C. (2010). Minimal clinically important difference for the ocular surface disease index. Archives of Ophthalmology, 128(1), 94–101. https://doi.org/10.1001/archophthalmol.2009.356

Nichols, K. K., Foulks, G. N., Bron, A. J., & Sullivan, D. A. (n.d.). Meibomian gland dysfunction: What is it, why does it occur and how may it be treated? (Report). https://www.tearfilm.org/pdfs/TFOS_Mgd_Report_Overview.pdf

Paulsen, A. J., Cruickshanks, K. J., Fischer, M. E., Huang, G.-H., Klein, B. E. K., Klein, R., & Dalton, D. S. (2014). Dry eye in the Beaver Dam offspring study: Prevalence, risk factors, and health-related quality of life. American Journal of Ophthalmology, 157(4), 799–806. https://doi.org/https://doi.org/10.1016/j.ajo.2013.12.023

Schiffman, R. M., Christianson, M. D., Jacobsen, G., Hirsch, J. D., & Reis, B. L. (2000). Reliability and validity of the Ocular Surface Disease Index. Archives of Ophthalmology, 118(5), 615–21. https://doi.org/10.1001/archopht.118.5.615

Stapleton, F., Alves, M., Bunya, V. Y., Jalbert, I., Lekhanont, K., Malet, F., Na, K. S., Schaumberg, D., Uchino, M., Vehof, J., Viso, E., Vitale, S., & Jones, L. (2017). TFOS DEWS II Epidemiology report. The Ocular Surface, 15(3), 334–365. https://doi.org/10.1016/j.jtos.2017.05.003

The Epidemiology of Dry Eye Disease: Report of the Epidemiology Subcommittee of the International Dry Eye WorkShop. (2007). The Ocular Surface, 5(2), 93–107. https://doi.org/https://doi.org/10.1016/S1542-0124(12)70082-4

Tomlinson, A., Bron, A. J., Korb, D. R., Amano, S., Paugh, J. R., Pearce, E. I., Yee, R., Yokoi, N., Arita, R., & Dogru, M. (2011). The international workshop on meibomian gland dysfunction: Report of the diagnosis subcommittee. Investigative Ophthalmology & Visual Science, 52(4), 2006–49. https://doi.org/10.1167/iovs.10-6997f

Uchino, M., Dogru, M., Yagi, Y., Goto, E., Tomita, M., Kon, T., Saiki, M., Matsumoto, Y., Uchino, Y., Yokoi, N., Kinoshita, S., & Tsubota, K. (2006). The features of dry eye disease in a Japanese elderly population. Optometry and Vision Science, 83(11), 797–802. https://doi.org/10.1097/01.opx.0000232814.39651.fa

Uchino, M., Uchino, Y., Dogru, M., Kawashima, M., Yokoi, N., Komuro, A., Sonomura, Y., Kato, H., Kinoshita, S., Schaumberg, D. A., & Tsubota, K. (2014). Dry eye disease and work productivity loss in visual display users: The Osaka study. American Journal of Ophthalmology, 157(2), 294–300. https://doi.org/10.1016/j.ajo.2013.10.014

van Tilborg, M. M., Murphy, P. J., & Evans, K. S. (2015). Agreement in dry eye management between optometrists and general practitioners in primary health care in the Netherlands. Contact Lens and Anterior Eye, 38(4), 283–93. https://doi.org/10.1016/j.clae.2015.03.005

Viso, E., Gude, F., & Rodríguez-Ares, M. T. (2011). The association of meibomian gland dysfunction and other common ocular diseases with dry eye: A populationbased study in Spain. Cornea, 30(1), 1–6. https://doi.org/10.1097/ICO.0b013e3181da5778

Wan, K. H., Chen, L. J., & Young, A. L. (2016). Depression and anxiety in dry eye disease: A systematic review and meta-analysis. Eye (Lond), 30(12), 1558–1567. https://doi.org/10.1038/eye.2016.186

Willcox, M. D. P., Argueso, P., Georgiev, G. A., Holopainen, J. M., Laurie, G. W., Millar, T. J., Papas, E. B., Rolland, J. P., Schmidt, T. A., Stahl, U., Suarez, T., Subbaraman, L. N., Ucakhan, O. O., & Jones, L. (2017). TFOS DEWS II Tear film report. The Ocular Surface, 15(3), 366–403. https://doi.org/10.1016/j.jtos.2017.03.006

Wolffsohn, J. S., Arita, R., Chalmers, R., Djalilian, A., Dogru, M., Dumbleton, K., Gupta, P. K., Karpecki, P., Lazreg, S., Pult, H., Sullivan, B. D., Tomlinson, A., Tong, L., Villani, E., Yoon, K. C., Jones, L., & Craig, J. P. (2017). TFOS DEWS II Diagnostic

methodology report. The Ocular Surface, 15(3), 539–574. https://doi.org/10.1016/j.jtos.2017.05.001

Xiao, J., Adil, M. Y., Chen, X., Utheim Ø, A., Ræder, S., Tønseth, K. A., Lagali, N. S., Dartt, D. A., & Utheim, T. P. (2020). Functional and morphological evaluation of meibomian glands in the assessment of meibomian gland dysfunction subtype and severity. American Journal of Ophthalmology, 209, 160–167. https://doi.org/10.1016/j.ajo.2019.09.005

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Ystenæs, A. E., Sand, I., & Sundling, V. Case finding of dry eye disease in Norwegian optometric practice: a cross-sectional study . Scandinavian Journal of Optometry and Visual Science, 14(1), 1–6. https://doi.org/10.5384/sjovs.v14i1.131

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Scientific Article