Dry eye symptoms using the Ocular Surface Disease Index in Sweden: a short report from a pilot study





Dry eye, OSDI, ocular surface


The aim of this study was to investigate the prevalence of dry eye symptoms in the Swedish population using a web-based version of the ocular surface disease index (OSDI). 

A web-based version of the OSDI questions was implemented in an online form using a software developed by Artologik. The link to the form was distributed via Linnaeus University social media pages. Basic demographic information such as age, sex and county of residence was also collected.

A total of 404 complete responses were received, 303 respondents (75%) were females, the median age = 39 (interquartile range = 28-53) years, median OSDI-score = 19 (interquartile range = 9-32). Crude prevalence of dry eye symptoms (categories mild to severe) was 65% (95% CI = 62-75). The difference in prevalence between males and females was statistically significant (chi-square test, p = 0.007).


The current study found that the prevalence of dry eye symptoms among a sample of the Swedish population was 65%. These results highlight the need to investigate further the prevalence and risk factors for dry eye disease in the Swedish population.


Asiedu, K., Kyei, S., Mensah, S. N., Ocansey, S., Abu, L. S., & Kyere, E. A. (2016). Ocular Surface Disease Index (OSDI) versus the Standard Patient Evaluation of Eye Dryness (SPEED): A Study of a nonclinical sample. Cornea, 35(2), 175–80. https://doi.org/10.1097/ico.0000000000000712

Bakkar, M. M., Shihadeh, W. A., Haddad, M. F., & Khader, Y. S. (2016). Epidemiology of symptoms of dry eye disease (DED) in Jordan: A cross-sectional non-clinical population-based study. Contact Lens and Anterior Eye, 39(3), 197–202. https://doi.org/10.1016/j.clae.2016.01.003

Caffery, B., Srinivasan, S., Reaume, C. J., Fischer, A., Cappadocia, D., Siffel, C., & Chan, C. C. (2019). Prevalence of dry eye disease in Ontario, Canada: A population-based survey. The Ocular Surface, 17(3), 526–531. https://doi.org/10. 1016/j.jtos.2019.02.011

Choi, J. H., Li, Y., Kim, S. H., Jin, R., Kim, Y. H., Choi, W., You, C., & Yoon, K. C. (2018). The influences of smartphone use on the status of the tear film and ocular surface. PLoS ONE, 13(10). https://doi.org/10.1371/journal.pone.0206541

Craig, J. P., Nelson, J. D., Azar, D. T., Belmonte, C., Bron, A. J., Chauhan, S. K., de Paiva, C. S., Gomes, J. A. P., Hammitt, K. M., Jones, L., Nichols, J. J., Nichols, K. K., Novack, G. D., Stapleton, F. J., Willcox, M. D. P., Wolffsohn, J. S., & Sullivan, D. A. (2017). TFOS DEWS II report executive summary. The Ocular Surface, 15(4), 802–812. https://doi.org/10.1016/j.jtos.2017.08.003

Dougherty, B. E., Nichols, J. J., & Nichols, K. K. (2011). Rasch analysis of the Ocular Surface Disease Index (OSDI). Investigative Ophthalmology & Visual Science, 52(12), 8630–5. https://doi.org/10.1167/iovs.11-8027

Efron, N. (2018). Contact lens practice (Third Edition). Elsevier.

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/10.1016/j.ajo.2017.06.033

Hashmani, N., Mustafa, F. G., Tariq, M. A., Ali, S. F., Bukhari, F., Memon, A. S., & Hashmani, S. (2020). Distribution and correlation of Ocular Surface Disease Index scores in a non-clinical population: The Karachi Ocular Surface Disease Study. Cureus, 12(7), e9193–e9193. https://doi.org/10.7759/cureus.9193

Hernandez-Llamas, S., Paz-Ramos, A. K., Marcos-Gonzalez, P., Amparo, F., & Garza-Leon, M. (2020). Symptoms of ocular surface disease in construction workers: Comparative study with office workers. BMC Ophthalmology, 20(1), 272. https://doi.org/10.1186/s12886-020-01548-0

Inomata, T., Nakamura, M., Iwagami, M., Shiang, T., Yoshimura, Y., Fujimoto, K., Okumura, Y., Eguchi, A., Iwata, N., Miura, M., Hori, S., Hiratsuka, Y., Uchino, M., Tsubota, K., Dana, R., & Murakami, A. (2019). Risk factors for severe dry eye disease: Crowdsourced research using DryEyeRhythm. Ophthalmology, 126(5), 766–768. https://doi.org/10.1016/j.ophtha.2018.12.013

Javadi, M.-A., & Feizi, S. (2011). Dry eye syndrome. Journal of Ophthalmic & Vision Research, 6(3), 192–198. https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC3306104/

Kaštelan, S., Tomić, M., Salopek-Rabatić, J., & Novak, B. (2013). Diagnostic procedures and management of dry eye. BioMed Research International, 2013, 309723–309723. https://doi.org/10.1155/2013/309723

Morgan, P. B., Woods, A., C, Tranoudis, G. I., Efron, N., Jones, L., Nelson, L., Merchan, B., Grupcheva, C. N., Jones, D., Beeler-Kaupke, M., Krasnanska, J., Bělová, Š., Ravn, O., Santodomingo-Rubido, J., Taste, P., Malet, F., Plakitsi, A., Végh, M., Erdinest, N., ... Nichols, J. J. (2019). International contact lens prescribing in 2019. Contact Lens Spectrum, (January 2020), 26–32.

Nelson, E. C., Eftimovska, E., Lind, C., Hager, A., Wasson, J. H., & Lindblad, S. (2015). Patient reported outcome measures in practice. BMJ, 350, g7818. https://doi.org/10.1136/bmj.g7818

Okumura, Y., Inomata, T., Iwata, N., Sung, J., Fujimoto, K., Fujio, K., Midorikawa-Inomata, A., Miura, M., Akasaki, Y., & Murakami, A. (2020). A review of dry eye questionnaires: Measuring patient-reported outcomes and health-related quality of life. Diagnostics (Basel), 10 (8). https://doi.org/10.3390/diagnostics10080559

Pesudovs, K., Ratcliffe, J., Lamoureux, E. L., Lundström, M., Massof, R. W., & Rubin, G. S. (2013). Measuring the patient’s perspective. Optometry and Vision Science, 90(8), 717–9. https://doi.org/10.1097/01.opx.0000432565.70467.75

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

Shanti, Y., Shehada, R., Bakkar, M. M., & Qaddumi, J. (2020). Prevalence and associated risk factors of dry eye disease in 16 northern West bank towns in Palestine: A cross-sectional study. BMC Ophthalmology, 20(1), 26. https://doi.org/10. 1186/s12886-019-1290-z

Sherry, A., Aridi, M., & Ghach, W. (2020). Prevalence and risk factors of symptomatic dry eye disease in Lebanon. Contact Lens and Anterior Eye, 43(4), 355– 358. https://doi.org/10.1016/j.clae.2019.08.001

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

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., Nishiwaki, Y., Michikawa, T., Shirakawa, K., Kuwahara, E., Yamada, M., Dogru, M., Schaumberg, D. A., Kawakita, T., Takebayashi, T., & Tsubota, K. (2011). Prevalence and risk factors of dry eye disease in Japan: Koumi study. Ophthalmology, 118(12), 2361–7. https://doi.org/10.1016/j.ophtha.2011.05.029

Uchino, M., Yokoi, N., Uchino, Y., Dogru, M., Kawashima, M., Komuro, A., Sonomura, Y., Kato, H., Kinoshita, S., Schaumberg, D. A., & Tsubota, K. (2013). Prevalence of dry eye disease and its risk factors in visual display terminal users: The Osaka Study. American Journal of Ophthalmology, 156(4), 759–766.e1. https://doi.org/10.1016/j.ajo.2013.05.040

Um, S. B., Kim, N. H., Lee, H. K., Song, J. S., & Kim, H. C. (2014). Spatial epidemiology of dry eye disease: Findings from South Korea. International Journal of Health Geography, 13, 31. https://doi.org/10.1186/1476-072x-13-31

Valderas, J. M., Kotzeva, A., Espallargues, M., Guyatt, G., Ferrans, C. E., Halyard, M. Y., Revicki, D. A., Symonds, T., Parada, A., & Alonso, J. (2008). The impact of measuring patient-reported outcomes in clinical practice: A systematic review of the literature. Quality of Life Research, 17(2), 179–193. https://doi.org/10.1007/ s11136-007-9295-0

Walt, J. G., Rowe, M. M., & Stern, K. L. (1997). Evaluating the functional impact of dry eye: The ocular surface disease index. Drug Information Journal, 31, 1436.

Willcox, M. D. P., Argüeso, 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., Uçakhan, O. Ö., & 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

Zhang, Y., Chen, H., & Wu, X. (2012). Prevalence and risk factors associated with dry eye syndrome among senior high school students in a county of shandong province, china. Ophthalmic Epidemiol, 19(4), 226–30. https://doi.org/10.3109/ 09286586.2012.670742

Bond, T. G., & Fox, C. M. (2015). Applying the Rasch model. fundamental measurement in the human sciences (3rd Edition). Routledge.

Boone, W. J., & Noltemeyer, A. (2017). Rasch analysis: A primer for school psychology researchers and practitioners. Cogent Education, 4(1), 1416898. https: //doi.org/10.1080/2331186X.2017.1416898

Brentani, E., & Golia, S. (2007).

Unidimensionality in the Rasch model: How to detect and interpret. Statistica, 67(3), 253–261. https://doi.org/10.6092/issn.1973-2201/3508

Dogan, A. S., Karabulut, E., & Gurdal, C. (2020). Validation and reliability of the Turkish version of Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8). Contact Lens and Anterior Eye, 43(5), 472–475. https://doi.org/10.1016/j. clae.2020.02.002

Glas, C., & Verhelst, N. (1995). Testing the Rasch model. In G. H. Fischer & I. W. Molenaar (Eds.), Rasch models: Foundations, developments and recent applications (pp. 69–96). New York: Springer Verlag.

Hobart, J. C., Cano, S. J., Zajicek, J. P., & Thompson, A. J. (2007). Rating scales as outcome measures for clinical trials in neurology: Problems, solutions, and recommendations. The Lancet Neruology, 6(12), 1094–105. https://doi.org/10.1016/ s1474-4422(07)70290-9

Ishaque, S., Karnon, J., Chen, G., Nair, R., & Salter, A. B. (2019). A systematic review of randomised controlled trials evaluating the use of patient-reported outcome measures (proms). Quality of Life Research, 28(3), 567–592. https://doi. org/10.1007/s11136-018-2016-z

Kandel, H., Khadka, J., Lundström, M., Goggin, M., & Pesudovs, K. (2017). Questionnaires for measuring refractive surgery outcomes. Journal of Refractive Surgery, 33(6), 416–424. https://doi.org/10.3928/1081597x-20170310-01

Khadka, J., McAlinden, C., & Pesudovs, K. (2013). Quality assessment of ophthalmic questionnaires: Review and recommendations. Optometry and Vision Science, 90(8), 720–44. https://doi.org/10.1097/opx.0000000000000001

Linacre, J. M. (1992). Prioritizing misfit indicators. Rasch Measurement Transactions, 9(2), 422–423.

Linacre, J. M. (1994). Sample size and item calibration [or person measure] stability. https://www.rasch.org/rmt/rmt74m.htm

Linacre, J. M. (1998). Detecting multidimensionality: Which residual data-type works best? Journal of Outcome Measurement, 2(3), 266–83.

Linacre, J. M. (2002). What do Infit and Outfit, mean-square and standardized mean? Rasch Measurement Transactions, 16(2), 878.

Linacre, J. M., & Wright, B. (1989). The “length” of a logit. Rasch Measurement Transactions, 3(2), 54–55.

Macedo, A. F., Ramos, P. L., Hernandez-Moreno, L., Cima, J., Baptista, A. M. G., Marques, A. P., Massof, R., & Santana, R. (2017). Visual and health outcomes, measured with the activity inventory and the EQ-5D, in visual impairment. Acta Ophthalmologica, 95(8), e783–e791. https://doi.org/10.1111/aos. 13430

Melin, J., Fornazar, R., Spångfors, M., & Pendrill, L. (2020). Rasch analysis of the Patient Participation in Rehabilitation Questionnaire (PPRQ). Journal of Evaluation in Clinical Practice, 26(1), 248–255. https://doi.org/10.1111/ jep.13134

Pallant, J. F., & Tennant, A. (2007). An introduction to the Rasch measurement model: An example using the Hospital Anxiety and Depression Scale (HADS). British Journal of Clinical Psychology, 46(1), 1–18. https://doi.org/ 10.1348/014466506X96931

Petrillo, J., Cano, S. J., McLeod, L. D., & Coon, C. D. (2015). Using classical test theory, item response theory, and Rasch measurement theory to evaluate patient-reported outcome measures: A comparison of worked examples. Value in Health, 18 (1), 25–34. https://doi.org/10.1016/j.jval.2014.10.005

Sjaastad, J. (2014). Enhancing measurement in science and mathematics education through rasch analysis: Rationale and properties. Nordic Studies in Science Education, 10 (2), 212–230. https://doi.org/10.5617/nordina.662

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How to Cite

Roth, J., Nilsson, I., Melin, J., & Macedo, A. F. (2022). Dry eye symptoms using the Ocular Surface Disease Index in Sweden: a short report from a pilot study. Scandinavian Journal of Optometry and Visual Science, 15(1). https://doi.org/10.5384/sjovs.v15i1.146



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