Abstract
Purpose: To determine the prevalence and risk factors of dry eye disease in Geriatric (>65 years) and Pre-geriatric (40-65 years) populations and to compare the same between both the groups. Setting: Indira Gandhi Government General Hospital and Post graduate Institute, Puducherry, India Design: Prospective, cross-sectional, clinical study Methods: All patients above 40 years attending the out-patient departments were given the Mc Monnie and Ho screening questionnaire for dry eye symptoms and risk factors. Those with a score of > 14.5 were further evaluated using Ocular Surface Disease Index (OSDI) severity subjective questionnaire, and objective clinical tests inclusive of Schirmer’s test, Meibomian Gland Dysfunction (MGD) assessment, Tear Film Break Up Time (TBUT), Fluorescein staining and Impression cytology. The prevalence, risk factors, clinical signs and symptom-sign correlation were determined and compared between the two groups. Results: Among the 1029 patients screened, the prevalence of dry eye was 9.9%, being significantly higher among the geriatric (15.4%) versus pre-geriatric group (7.7%), p<0.000, among women (12%) versus men (6.6%), p<0.000, among arthritic (22.8%) versus non-arthritic (9.6%), p=0.005, and among diabetic (30.4%) versus non-diabetic patients (3.4%), p<0.000. Geriatric patients had a greater prevalence of Grade 4 MGD (66%) versus pre- geriatric group (26.9%), p<0.000. TBUT scores were low (<10 seconds) in both groups and co-related with OSDI symptom severity scores (r=1). Conclusions: Aging, female gender, arthritis and diabetes were found to be significant risk factors. The Mc-Monnie and Ho questionnaire is a valid screening tool only for evaporative dry eye and is complemented by OSDI for screening in a hospital based setting.
Highlights
Dry eye is a multi-factorial disease of the tear film and ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability with potential damage to the ocular surface
Arthritis and diabetes were significantly associated with dry eye
Dry eye clinical signs analysis in those with a Mc Monnie score of ≥ 14.5 revealed that there was a significantly greater severity of Meibomian gland dysfunction in the geriatric compared to the pre geriatric population
Summary
Dry eye is a multi-factorial disease of the tear film and ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability with potential damage to the ocular surface. Understanding why the elderly and middle-aged population is at a higher risk of developing dry eye disease can help us to minimize the burden of disease on the aged population. We proposed to identify dry eye disease in the geriatric age group (>65 years) and pre geriatric middle aged population(40 to 65 years) attending our tertiary care hospital in South India with symptoms suggestive of dry eye disease in order to estimate the prevalence and associated risk factors thereof. We looked at the diagnostic efficacy of the Mc Monnie and Ho and OSDI (symptom severity) questionnaires
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