Prevalence of Dry Eye Disease Among Individuals Scheduled for Cataract Surgery in a Norwegian Cataract Clinic

Figures & data

Table 1 Demographics and Characteristics of DED Negative (DED-) versus DED Positive (DED+) Subjects According to DEWSII Criteria

Parameters	DED-^c (n=97)	DED+^d (n=121)	P-value
Median age in years (IQR)	76 (7)	74 (9)	0.013^b*
Females in %	48.5	63.6.	0.024^a*
Use of eye drops in %	23.7	33.1	0.121^a
Diabetes in %	16.4	19	0.590^a
Autoimmune disease in %	9.3	9.1	0.977^a
Cholesterol medication in %	37.1	32.2	0.477^a
Antihypertensives in %	57.7	54.5	0.738^a
Glaucoma eye drops in %	4.1	3.3	0.759^a
Smokers in %	10.3	10.7	0.917^a
Heat pump at home in %	64.9	62	0.652^a
Median AI in days (IQR)	3 (5)	2.9 (4)	0.571^b
Median BMI (IQR)	24.7 (6)	24.9 (5.1)	0.381^b

Notes: ͣ Pearson’s Chi-square test for categorical data, ^bMann–Whitney U-test for continuous data. ^cDED-: Normal OSDI, osmolarity, CFS and NIKBUT; ^d DED+: OSDI ≥ 13, plus at least one positive score of osmolarity, CFS and/or NIKBUT, * Statistically significant, p <0.05.

Abbreviations: IQR, interquartile range; BMI, body mass index; OSDI, ocular surface disease index; NIKBUT, non invasive keratography break up time; CFS, corneal fluorescein staining; TFOS DEWSII, Tear film and Ocular Surface Society Dry Eye Workshop; AI, Activity level, Physical activity/exercise level.

Figure 1 The prevalence of DED in % based on DEWS II criteria, subdivided based on dry eye tests.

Abbreviations: DED, dry eye disease; DEWS II criteria, According to the Tear Film & Ocular Surface society (TFOS) symptoms and at least one positive result of the markers of homeostasis (Osmolarity, NIKBUT and CFS); OSDI, ocular surface disease Index; SPEED, standard patient evaluation of eye dryness; CFS, corneal fluorescein staining; NIKBUT, non-Invasive keratograph break-up time; MGD, meibomian gland dysfunction; TFT, tear film thickness.

Table 2 Association Between DED and Its Signs and Symptoms with Age and Gender in a Simple Logistic Regression Model

	Age (Years)			Gender (Male/Female)
		OR (95% CI)	p-value		OR (95% CI)	p-value
DED DEWSII criteria	0.96	(0.92–1.00)	0.090	1.76	(1.10–3.06)	0.004*
OSDI (≥13)	0.92	(0.87–0.97)	0.003*	1.53	(0.83–2.80)	0.169
SPEED (≥4)	0.96	(0.92–1.01)	0.174	1.04	(0.58–1.88)	0.876
Osmolarity (≥308, diff>8mOsm/L)	0.98	(0.94–1.02)	0.449	1.30	(0.73–2.31)	0.389
CFS (≥ grade 2)	1.05	(0.99–1.12)	0.061	1.19	(1.05–4.53)	0.035*
NIKBUTavg (≤10 seconds)	1.02	(0.97–1.07)	0.281	2.00	(1.08–3.70)	0.028*
Schirmer (< 10 mm)	1.00	(0.96–1.05)	0.68	0.90	(0.52–1.55)	0.713
CS (< 60 mm)	1.08	(1.02–1.13)	0.002*	1.22	(0.68–2.15)	0.514
Meiboscore (≥ grade 1)	1.06	(1.01–1.12)	0.01*	0.69	(0.33–1.44)	0.338
TFT (< 75 nm)	0.99	(0.95–1.03)	0.83	0.77	(0.44–1.34)	0.372

Notes: * Statistically significant, p <0.05.

Abbreviations: OR, odds ratio; CI, confidence interval; DED DEWS II, Dry eye disease based on DEWS II criteria; OSDI, ocular surface disease index; SPEED, standard patient evaluation of eye dryness; CFS, corneal fluorescein staining; NIKBUT, non-invasive keratograph break-up time; CS, Corneal Sensitivity; TFT, tear film thickness.

Table 3 Distribution of Abnormal Tests in the Study Population (%)

Test	Cutoff	Symptomatic^a (n =155)	Asymptomatic^b (n =63)	Total (n= 218)	p-value
Osmolarity	≥308 mOsms/L	107 (74)	38 (26)	145 (66.5)	0.217
CFS	≥grade 2	28 (18)	15 (34)	43 (19.7)	0.334
NIKBUTaverage	< 10 seconds	49 (75)	16 (25)	65 (29.8)	0.363
Schirmer 1	<10 mm	90 (72.5)	34 (27.5)	124 (56.9)	0.580
Corneal sensibility	<60 mm	63 (75)	21 (25)	84 38.8)	0.337
Meiboscore	≥Grade 1	126 (71.5)	50 (28.5)	176 (80.7)	0.954
TFT	<75nm	74 (71)	30 (29)	104 (47.7)	0.896

Notes: ^a OSDI ≥ 13, ^b OSDI <13.

Abbreviations: OSDI, ocular surface disease index; SPEED, standard patient evaluation of eye dryness; CFS, corneal fluorescein staining; NIKBUT, non-Invasive keratograph break-up time; TFT, tear film thickness.

Table 4 Correlation Matrix of Objective DED Test and Subjective Questionnaires, Spearman`s Rho Correlation Coefficient

Test	Age	OSDI	SPEED	Osmolarity	NIKBUT avg	CFS	TFT	Schirmer 1	Meibo	CS
Age OSDI	−0.172*
SPEED	−0.143*	0.621*
Osmolarity	−0.104	0.075	0.102
NIKBUTavg	−0.023	−0.127	−0.176*	−0.138*
CFS	0.055	0.020	0.059	0.178*	0.181*
TFT	0.023	0.123	0.179*	0.024	0.063	0.208*
Schirmer 1	−0.012	−0.035	0.015	0.112	0.055	0.175*	0.079
Meiboscore	0.257*	−0.089	0.012	0.065	−0.066	0.107	0.026	0.053
CS	−0.171*	0.065	−0.013	−0.200*	−0.045	−0.270*	−0.177*	0.159*	0.142*

Notes: * Statistically significant; p < 0.05.

Abbreviations: OSDI, ocular surface disease index; SPEED, standard patient evaluation of eye dryness; CFS, corneal fluorescein staining; NIKBUTavg, non-Invasive keratograph break-up time; TFT, tear film thickness; CS, corneal sensitivity.

Figure 2 Distribution of: osmolarity grading severity (A), corneal fluorescein staining (CFS) (B), abnormal non-invasive keratography breakup time (NIKBUT) (C) in the study population.

Figure 3 Distribution of: the ocular surface disease index (OSDI) questionnaire score (A), the standard patient evaluation of eye dryness questionnaire (SPEED) score in the study population (B).

Table 5 Matrix Results of the Severity of Dry Eye Symptoms Based on the Ocular Surface Disease Index (OSDI) and the Number of Positive DED Signs (Osmolarity, NIKBUTavg, CSF)

		Number of DED Signs
		0	1	2	3
Test	Severity	%	%	%	%
OSDI	Normal (0–12)	6.5	10.6	8.7	3.2
	Mild (13–22)	4.1	4.6	5.5	1.8
	Moderate (23–32)	5.9	4.1	6.4	2.8
	Severe (22–100)	4.6	13.3	11.9	5.5

Abbreviations: DED, dry eye disease; OSDI, ocular surface disease index; NIKBUTavg, non-Invasive keratograph break-up time; CFS, corneal fluorescein staining.