Current Estimates Uncertain on the Prevalence of Dry Eye in United States

Tianjing Li, MD, MHS, PhD

A recent systematic review and meta-analysis reported uncertainty on the estimates of the prevalence of dry eye disease (DED) and meibomian gland dysfunction (MGD) in the United States population.

The study data suggest the prevalence of dry eye ranged from 5.3% to 14.5% and the prevalence of MGD ranged from 10.4% to 55.4%.

Investigators at the University of Colorado Anschutz noted this wide range of prevalence estimates for dry eye reflected the notable clinical and methodological heterogeneity across studies.

“Studies included in the meta-analysis had diverse population characteristics, variations in study designs and settings, and heterogeneous definitions of dry eye, which increase our uncertainty in the summary prevalence estimate,” wrote study author Tianjing Li, MD, MHS, PhD, Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus.

A common clinical manifestation, dry eye can be a considerable burden to patients and society, with direct economic costs and estimated societal costs totaling billions of dollars per year.

Population-based, clinic-based, and secondary healthcare database studies that reported prevalence or incidence of dry eye or MGD in the United States were included in the current study. Investigators searched Ovid Medline and Embase in August 2021, limiting the search to studies published during or after January 2010.

They investigated clinical heterogeneity with an assessment of diversity in population and disease characteristics and assessed methodological heterogeneity by evaluating study designs and risk of bias. The prevalence of dry eye and MGD were combined in separate meta-analyses using random-effects models. Summary estimates from the meta-anslusis reported 95% confidence intervals (CIs) and 95% prediction intervals (PIs).

Investigators included 13 studies in the systematic review, covering 3 topics: dry eye prevalence (n = 10), dry eye incidence (n = 2), and MGD prevalence (n = 3).

The primary analysis suggested the prevalence of dry eye ranged from 5.3% to 4.5%, with a summary estimate of 8.1% (95% CI, 4.9% - 13.1%; 95% PI, 0% - 98.9%; 3 studies, 9,808,758 participants).

Meanwhile, the prevalence of MGD ranged from 10.4% to 55.4% in the 3 included studies, while the pooled estimate of MGD prevalence was 21.2% (95% CI, 7.2% - 48.3%; 95% PI, 0% - 100%; 3 studies, 19,648 participants).

The study data from 2 studies contributing to dry eye incidence suggest the incidence was 3.5% in a population 18 years and older and 7.8% in a population aged 68 years and older.

Li and investigators suggested future epidemiological studies may improve with the development of a standard set or diagnostic criteria for DED.

They pointed out the few MGD incidence studies and differences in clinical signs used to diagnose MGD additionally undermined the certainty of the prevalence estimates in the review.

“However, our pooled estimate of dry eye prevalence was consistent with those reported by previous studies conducted in the time frame prior to that for our review,” Li added.

The study, “Prevalence and Incidence of Dry Eye and Meibomian Gland Dysfunction in the United States: A Systematic Review and Meta-analysis,” was published in JAMA Ophthalmology.