Prevalence and Risk Factors of Dry Eye Disease after Refractive Surgery

Yong Son Dae; Hwang Sungsoon; Hyun Joo; Hui Lim Dong; MD Eui Sang Chung,; MD Tae-Young Chung,

doi:10.3341/jkos.2017.58.7.782

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Dae, Sungsoon, Joo, Dong, Eui Sang Chung,, and Tae-Young Chung,: Prevalence and Risk Factors of Dry Eye Disease after Refractive Surgery

Original Article

J Korean Ophthalmol Soc 2017;58(7):782-787.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.7.782

Prevalence and Risk Factors of Dry Eye Disease after Refractive Surgery

Yong Son Dae, M.D.¹, Hwang Sungsoon, M.D.¹, Hyun Joo, M.D.^1,², Hui Lim Dong, M.D.¹, MD Eui Sang Chung,, PhD^1,³, MD Tae-Young Chung,, PhD^1,

¹Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

²Saevit Eye Center, Goyang, Korea

³Rhee’s Eye Hospital, Daejeon, Korea

Address reprint requests to Tae-Young Chung, MD, PhD Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: 82-2-3410-3548, Fax: 82-2-3410-0074 E-mail: tychung@skku.edu

* Conflicts of Interest: The authors have no conflicts to disclose.

Received 17 March 201725 May 2017 Accepted 27 June 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess the prevalence and the risk factors of dry eye disease after refractive surgery.

Methods

A retrospective study was performed on 180 eyes of 98 patients based on medical records. Those who had tear break-up time less of than 5 seconds or had an Oxford stain scale equal to or greater than 2 were defined to have dry eye disease. We analyzed the prevalence of dry eye, compared demographic and clinical features of the dry eye group and normal group, and found risk factors of dry eye after refractive surgery.

Results

The prevalence of postoperative dry eye was 62.2%. Compared to the normal eye group, the dry eye group had a sig-nificantly higher proportion of women (p = 0.016), older age (p = 0.001), and thin cornea (p = 0.002). The most significant risk fac-tor of dry eye after refractive surgery was presence of dry eye before refractive surgery (odds ratio [OR] = 9.02, confidence inter-val [CI] = 3.8-21.4). Old age was also found to be an independent risk factor of dry eye after refractive surgery (OR = 1.06, CI = 1.01-1.11).

Conclusions

The risk of dry eye after refractive surgery was increased in older age and preoperative dry eye disease. In order to prevent post-refractive surgery dry eye, caution should be exercised in middle aged patients with preoperative dry eye disease.

Keywords: Dry eye, Prevalence, Refractive surgery, Risk factor

References

1. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007; 5:75–92.

2. Uchino M, Dogru M, Yagi Y. . The features of dry eye disease in a Japanese elderly population. Optom Vis Sci. 2006; 83:797–802.

3. Schaumberg DA, Dana R, Buring JE, Sullivan DA. Prevalence of dry eye disease among US men: estimates from the Physicians’ Health Studies. Arch Ophthalmol. 2009; 127:763–8.

4. Schein OD, Muñoz B, Tielsch JM. . Prevalence of dry eye among the elderly. Am J Ophthalmol. 1997; 124:723–8.

5. Moss SE, Klein R, Klein BE. Prevalence of and risk factors for dry eye syndrome. Arch Ophthalmol. 2000; 118:1264–8.

6. Lee AJ, Lee J, Saw SM. . Prevalence and risk factors asso-ciated with dry eye symptoms: a population based study in Indonesia. Br J Ophthalmol. 2002; 86:1347–51.

7. Chia EM, Mitchell P, Rochtchina E. . Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains Eye Study. Clin Experiment Ophthalmol. 2003; 31:229–32.

8. Lin PY, Tsai SY, Cheng CY. . Prevalence of dry eye among an elderly Chinese population in Taiwan: the Shihpai Eye Study. Ophthalmology. 2003; 110:1096–101.

9. Jie Y, Xu L, Wu YY, Jonas JB. Prevalence of dry eye among adult Chinese in the Beijing Eye Study. Eye (Lond). 2009; 23:688–93.

10. Chao C, Golebiowski B, Stapleton F. The role of corneal in-nervation in LASIK-induced neuropathic dry eye. Ocul Surf. 2014; 12:32–45.

11. Albietz JM, Lenton LM. Management of the ocular surface and tear film before, during, and after laser in situ keratomileusis. J Refract Surg. 2004; 20:62–71.

12. Albietz JM, Lenton LM, McLennan SG. Dry eye after LASIK: comparison of outcomes for Asian and Caucasian eyes. Clin Exp Optom. 2005; 88:89–96.

13. De Paiva CS, Chen Z, Koch DD. . The incidence and risk fac-tors for developing dry eye after myopic LASIK. Am J Ophthalmol. 2006; 141:438–45.

14. Shoja MR, Besharati MR. Dry eye after LASIK for myopia: Incidence and risk factors. Eur J Ophthalmol. 2007; 17:1–6.

15. Ambrósio R Jr, Tervo T, Wilson SE. LASIK-associated dry eye and neurotrophic epitheliopathy: pathophysiology and strategies for prevention and treatment. J Refract Surg. 2008; 24:396–407.

16. Nettune GR, Pflugfelder SC. Post-LASIK tear dysfunction and dysesthesia. Ocul Surf. 2010; 8:135–45.

17. Rosenfeld SI. Evaluation and management of post-LASIK dry eye syndrome. Int Ophthalmol Clin. 2010; 50:191–9.

18. Yun CM, Kang SY, Kim HM, Song JS. Prevalence of dry eye dis-ease among university students. J Korean Ophthalmol Soc. 2012; 53:505–9.

19. Jeong HS, Lim JS, Oh DK. . Prevalence and risk factors of Dry Eye Syndrome in the Incheon area. J Korean Ophthalmol Soc. 2011; 52:1135–41.

20. Jang H, Lee S, Kim TH. . Acupuncture for dry eye syndrome after refractive surgery: study protocol for a randomized controlled trial. Trials. 2013; 14:351.

21. Uchino M, Nishiwaki Y, Michikawa T. . Prevalence and risk factors of dry eye disease in Japan: Koumi study. Ophthalmology. 2011; 118:2361–7.

22. Han SB, Hyon JY, Woo SJ. . Prevalence of dry eye disease in an elderly Korean population. Arch Ophthalmol. 2011; 129:633–8.

23. Kim WJ, Kim HS, Kim MS. Current trends in the recognition and treatment of dry eye: a survery of ophthalmologists. J Korean Ophthalmol Soc. 2007; 48:1614–22.

24. Hyon JY, Kim HM, Lee D. . Korean guidelines for the diag-nosis and management of dry eye: development and validation of clinical efficacy. Korean J Ophthalmol. 2014; 28:197–206.

25. Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007; 5:108–52.

26. Tsubota K, Yokoi N, Shimazaki J. . New perspectives on dry eye definition and diagnosis: a consensus report by the Asia Dry Eye Society. Ocul Surf. 2017; 15:65–76.

27. Smith JA, Vitale S, Reed GF. . Dry eye signs and symptoms in women with premature ovarian failure. Arch Ophthalmol. 2004; 122:151–6.

28. Paulsen AJ, Cruickshanks KJ, Fischer ME. . Dry eye in the beaver dam offspring study: prevalence, risk factors, and health-re-lated quality of life. Am J Ophthalmol. 2014; 157:799–806.

29. Liu Z, Pflugfelder SC. Corneal thickness is reduced in dry eye. Cornea. 1999; 18:403–7.

30. Mathers WD, Lane JA, Zimmerman MB. Tear film changes asso-ciated with normal aging. Cornea. 1996; 15:229–34.

31. Damato BE, Allan D, Murray SB, Lee WR. Senile atrophy of the human lacrimal gland: the contribution of chronic inflammatory disease. Br J Ophthalmol. 1984; 68:674–80.

Table 1.

Comparison of preoperative characteristics between pre-operative normal and dry eye group, and post-operative norma and dry eye group^*

	Pre-operative			Post-operative
Normal (n = 97)	Dry eye (n = 83)	p-value^†	Normal (n = 68)	Dry eye (n = 112)	p-value^†
Sex (% of female)	56.7	84.3	<0.001	58.8	75.8	0.016
Age (years)	31.0 ± 10.4	33.8 ± 12.5	0.102	28.3 ± 9.5	34.7 ± 11.9	<0.001
Contact lens (% of wear)	42.2	51.8	0.203	39.7	0.51	0.146
Corneal thickness (μ m)	551.2 ± 26.6	536.2 ± 30.9	0.001	553.0 ± 33.0	539.0 ± 26.1	0.002
Ablation depth (μ m)	103.5 ± 38.8	99.0 ± 35.8	0.423	107.7 ± 36.1	97.6 ± 37.9	0.079
Refractive surgery (n, %)
LASIK	53 (54.6)	57 (68.7)	-	33 (48.5)	77 (68.8)	-
LASEK	24 (24.7)	13 (15.7)	-	20 (29.4)	17 (15.2)	-
SMILE	20 (20.6)	13 (15.7)	-	15 (22.1)	18 (16.1)	-

Values are presented as mean ± SD unless otherwise indicated. LASIK = laser in situ keratomileusis; LASEK = laser subepithelial keratomileusis; SMILE = small incision lenticule extraction.

^* Definition of dry eye: tear break-up time < 5 sec or Oxford stain score ≥ 2;

^† p-value by independent t-test.

Table 2.

Results of univariate logistic regression analysis for postoperative dry eye

Variables	Odds ratio (95% CI)	p-value^*
Sex (female)	2.20 (1.15-4.22)	0.017
Older age (every 1 year)	1.06 (1.02-1.09)	0.001
Contact lens use	1.57 (0.85-2.90)	0.146
Dry eye before refractive surgery	10.9 (5.0-23.6)	<0.001
Refractive surgery
LASIK		(ref)
LASEK	0.36 (0.17-0.78)	0.010
SMILE	0.51 (0.23-1.14)	0.102
Corneal thickness	0.98 (0.97-0.99)	0.003
Ablation thickness	0.99 (0.98-1.00)	0.080

CI = confidence interval; LASIK = laser in situ keratomileusis; LASEK = laser subepithelial keratomileusis; SMILE = small in-cision lenticule extraction; ref = reference category.

^* p-value by univariate logistic regression.

Table 3.

Results of multiple logistic regression analysis for postoperative dry eye

Variables	B	SE	Wals	Df	p-value^*	Exp (B)	95% CI
Sex (female)	-0.02	0.48	0.00	1	0.971	0.98	0.38-2.52
Older age (every 1 year)	0.06	0.02	6.47	1	0.011	1.06	1.01-1.11
Contact lens use	0.73	0.40	3.24	1	0.072	2.07	0.94-4.57
Dry eye before refractive surgery	2.20	0.44	25.1	1	<0.001	9.03	3.82-21.4
Refractive surgery
LASIK	(ref)	(ref)	3.72	2	(ref)	(ref)	(ref)
LASEK	-1.01	0.52	3.72	1	0.054	0.37	0.13-1.02
SMILE	-0.26	0.54	0.23	1	0.635	0.77	0.27-2.24
Corneal thickness	-0.01	0.01	3.21	1	0.073	0.99	0.97-1.00
Ablation thickness	0.00	0.01	0.02	1	0.885	1.00	0.99-1.02

B = log odds; SE = standard err; Wals = Wald statistic; Df = degrees of freedom; Exp (B) = odds; CI = confidence interval; LASIK = laser in situ keratomileusis; LASEK = laser subepithelial keratomileusis; SMILE = small incision lenticule extraction; ref = reference category.

^* p-value by multivariate logistic regression.

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