Abstract
This study evaluated the effect of gout on the risk of dry eye disease (DED) by using the National Health Insurance Research Database (NHIRD). Data for 30,192 gout patients (21,081 men and 9111 women) and 30,192 non-gout patients (21,005 men and 9187 women) were analyzed. Approximately 1 million patients were randomly sampled from the NHIRD registry. After applying exclusion criteria, patients diagnosed with gout were enrolled in the study group. Thereafter, each individual in the study group underwent the matching process via the propensity score with another non-gout individual, which constituted the control group. The main outcome was defined as the development of DED in accordance with the corresponding International Classification of Diseases, Ninth Revision. In addition to DED, other risk factors including age, sex, and urbanization, and several co-morbidities were included in the multivariate model. The incidence of DED with the adjusted hazard ratio (aHR) and cumulative probability were evaluated in the gout and non-gout patients. A total of 2913 DED events were observed in the study group, whereas 2631 DED events were observed in the control group. A higher incidence rate ratio was found in the study group after adjustment (aHR: 1.065). Moreover, the cumulative probability indicated a significantly increased risk of DED in the study group (p = 0.001). The other potential risk factors of DED according to the multivariate analysis include older age, female gender, higher degree of urbanization, keratopathy, age-related macular degeneration, glaucoma, cataract, ischemic heart disease, hyperlipidemia, peripheral vascular disease, chronic pulmonary disease, rheumatic disease, peptic ulcer disease, liver disease, and malignancy. In conclusion, gout increased the risk of DED after adjustment, and the risk is positively correlated to a longer disease period.
Highlights
The incidence of dry eye disease (DED), an ocular surface disorder characterized by dryness or a gritty sensation and even blurred vision or ocular pain [1,2], is increasing with a predominance of old age and female sex [2,3]
After the selection and exclusion (Figure 1), a total of 32,164 and 32,164 individuals were included in the study group and control group, respectively
The mean age was 54.86 (standard deviation (SD) = 17.02) in patients with gout, which was lower than the control group (Mean = 56.80, SD = 16.76), and the control group included more patients aged older than 60 years than did the study group
Summary
The incidence of dry eye disease (DED), an ocular surface disorder characterized by dryness or a gritty sensation and even blurred vision or ocular pain [1,2], is increasing with a predominance of old age and female sex [2,3]. The pathophysiology of DED involves excess evaporation, aqueous deficiency, and ocular surface damage, which result in an unstable tear film [4]. Common treatment strategies for DED include artificial tear lubrication, polyunsaturated fatty acid supplementation, and meibomian gland heating [5,6]. Immunosuppressants, such as cyclosporine, have been used in patients with DED for anti-inflammatory effects [6]. Sjögren syndrome leads to a decline in the lacrimal gland tissue and results in inadequate tear secretion and subsequent DED [7]. Because DED and systemic inflammatory disorders share a similar pathophysiology in immunoreaction [4,7], the increased systemic inflammatory status may increase the risk of DED
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