Prevalence of dry eye and Meibomian gland dysfunction in Central and South America: a systematic review and meta-analysis

Chen, Hongan; McCann, Paul; Lien, Tiffany; Xiao, Mengli; Abraham, Alison G.; Gregory, Darren G.; Hauswirth, Scott G.; Qureshi, Riaz; Liu, Su-Hsun; Saldanha, Ian J.; Li, Tianjing

doi:10.1186/s12886-023-03249-w

Table 2 Prevalence of dry eye and Meibomian gland dysfunction

From: Prevalence of dry eye and Meibomian gland dysfunction in Central and South America: a systematic review and meta-analysis

Population category	Author, publication year	Etiology	Measurement method: component(s) contributing to diagnostic standard(s)	Diagnostic standard(s)	Prevalence denominator	Prevalence numerator	Prevalence (%), 95% confidence interval	Point or period of data collection	Characteristics used to stratify prevalence or report an association	Overall risk of bias
General population-based	Castro, 2018 [33]	DED	Self-reported diagnosis; Symptoms	Self-reported diagnosis^a	3107	317	10.2, 95%CI* 9.2, 11.3	Point: n.r	¶ Sex, country / region; † Age, sex, medical comorbidities, medication use, other—computer exposure, smoking; ‡ Age, sex, medical comorbidities, medication use, other—computer exposure, smoking	M
				Symptoms (questionnaire)^b	3107	151	4.9, 95%CI* 4.1, 5.7
				Self reported diagnosis or symptoms (questionnaire)	3107	398	12.9, 95%CI* 11.7, 14.0
	Graue-Hernandez, 2018 [41]	DED	Symptoms	Symptoms (questionnaire)^c	1508	621	41.1, 95%CI 38.6, 43.6	Period: July to September 2013	¶ Dry eye symptom severity; † Sex, dry eye symptom severity, medical comorbidities (hypertension, diabetes mellitus), medication use (hypoglycemic, anti-hypertensive), country or region (rural/urban), other-smoking status, alcohol consumption, wearing glasses, cataract surgery, occupation, level of education; ‡ Sex, dry eye symptom severity, other–smoking index, ever alcohol consumption, medication use (anti-hypertensive)	M
Working populations	Castellanos-Gonzalez, 2016 [28]	DED / MGD	Symptoms; signs	Symptoms (questionnaire)^d	123	69	56.1, 95%CI* 46.9, 65.0	Point: 2014	¶ Medical comorbidities, medication use; other—year of residency, makeup use, microscope use; † n.r.; ‡ n.r.	M
				TBUT^e	123	70	56.9, 95%CI* 47.7, 65.8
				Corneal staining^f	123	30	24.4, 95%CI* 17.1, 32.9
				Schirmer I test^g	123	0	0, 95%CI* 0, 2.9^§
				Meibomian gland dysfunction^h	123	28	22.7, 95%CI* 15.7, 31.2
	Sanchez-Valerio, 2020 [30]	CVS	Symptoms; signs	Symptoms (questionnaire)^d	108	86*	79.7, 95%CI* 70.8, 86.7	Point: n.r	¶ Other—computer exposure degree; † Other—computer exposure times; ‡ n.r.	M
				TBUT^e	108	105*	97.2, 95%CI* 92.1, 99.4
				Ocular surface stainingⁱ	108	48*	44.4, 95%CI* 34.8, 54.3
				Schirmer I test^j	108	29*	26.9, 95%CI* 18.8, 36.2
	Hernandez-Llamas, 2020 [29]	DED	Symptoms	Symptoms (questionnaire)^d	Construction workers 149	Construction workers 53	Construction workers 35.6, 95% CI* 27.9, 43.8	Period: October and December 2017	¶ Age, sex, medical comorbidities (systemic disease), other–smoking status, contact lens use, computer hours/day, working hours/day, ocular disease, gender, smoking status, medical comorbidities, other– contact lens use, smoking status, office vs. construction worker, ocular disease; † Gender, smoking status, medical comorbidities, other– contact lens use, smoking status, office vs. construction worker, ocular disease; ‡ Gender, smoking status, medical comorbidities, other– contact lens use, smoking status, office vs. construction worker, ocular disease	H
	Hernandez-Llamas, 2020 [29]	DED	Symptoms	Symptoms (questionnaire)^d	Office workers 155	Office workers 112	Office workers 72.3, 95% CI* 64.5, 79.1	Period: October and December 2017		H
Student populations	Garza-Leon, 2016 [39]	DED	Symptoms	Symptoms (questionnaire)^d	823	579	70.4, 95% CI* 67.1, 73.5	Point: 2014	¶ Sex, dry eye symptom severity; † n.r.; ‡ Sex, other-smoking status, hours in front of computer, refractive surgery, eye drops user, contact lens user	M
	Cartes, 2021 [37]	CVS, DED	Self-reported diagnosis; Symptoms	Self-reported diagnosis (questionnaire)^k	1450	85	5.9, 95%CI* 4.7, 7.2	Point: May 2020	¶ Sex, dry eye symptoms; † Sex, medical comorbidities, medication use, other-smoking, contact lens use, screen exposure time; ‡ Sex, screen exposure time, medical comorbidities (previous dry eye disease diagnosis), medication use (allergy medication)	H
	Cartes, 2021 [37]	CVS, DED	Self-reported diagnosis; Symptoms	Symptoms (questionnaire)^c	1450	1123	77.4, 95%CI* 75.2, 79.6	Point: May 2020		H
	Garza-Leon, 2021 [40]	DED	Symptoms	Symptoms (questionnaire)^d	759	496	65.3, 95% CI* 61.8, 68.7	Point: n.r	¶ Sex, dry eye symptom severity; † Sex, other-contact lens use, contact lens type, contact lens wear overnight; ‡ Sex, other-contact lens use, contact lens type, contact lens wear overnight	M
Hospital- and clinic-based populations	Skare, 2012 [32]	DED	Symptoms; signs	Dry eye sensation	Pregnant 150	Pregnant 24	Pregnant 16.0, 95%CI* 10.5, 22.9	Point: n.r	¶ n.r.; † Pregnant vs non-pregnant and lacrimal dysfunction vs no lacrimal dysfunction, medication use, others—length of pregnancy, number of pregnancies, number of full-term pregnancies, number of abortions; ‡ n.r.	H
				Dry eye sensation	Non-pregnant 150	Non-pregnant 28	Non-pregnant 18.7, 95%CI* 12.8, 25.8
				Schirmer's test^l	Pregnant 150	Pregnant 26	Pregnant 17.3, 95%CI* 11.7, 24.4
				Schirmer's test^l	Non-pregnant 150	Non-pregnant 10	Non-pregnant 6.7, 95%CI* 3.2, 11.9
	Martinez JD, 2016 [36]	DED, MGD	Symptoms, Signs	Symptoms (questionnaire)^d	338	264	78.1, 95% CI* 73.3, 82.4	Period: November 2012 to February 2013	¶ Sex, age, dry eye symptom severity (OSDI, DEQ), medical comorbidities (diabetes mellitus, arthritis, thyroid problems, dry mouth, acne, depression), medication use (antihypertensive, antihistamine, diuretic, GI ulcer medication, multivitamins, lubricant eye drops), other–smoking, indoors occupation, exposure to air conditioning, contact lens use, ocular sugery; † Symptom severity (OSDI, DEQ-5), aqueous tear deficiency (Schirmer's), evaporative deficiency (TBUT), meibomian gland disease, corneal staining (Oxford) vs. Sex, age, medical comorbidities (diabetes mellitus, arthritis, thyroid problems, dry mouth, acne, depression), medication use (antihypertensive, antihistamine, diuretic, GI ulcer medication, multivitamins, lubricant eye drops), other–smoking, indoors occupation, exposure to air conditioning, contact lens use, ocular sugery; ‡ n.r.	M
				Symptoms (questionnaire)^c	338	248	73.4, 95% CI* 68.3, 78.0
				TBUT^m	338	319	94.4, 95% CI* 91.4, 96.6
				Corneal stainingⁿ	338	37	11.0, 95% CI* 7.8, 14.8
				Schirmer I test^o	338	74	21.9, 95% CI* 17.6, 26.7
				Meibomian gland dysfunction^p	338	228	67.5, 95% CI* 62.2, 72.4
	Garza-Leon, 2017 [35]	DED	Symptoms	Symptoms (questionnaire)^d	2270	1967	86.4, 95% CI* 85.2, 88.0	Period: September to December 2014	¶ Sex, dry eye symptoms severity; † Age, dry eye symptoms severity; ‡ Sex, age, other- referring physician specialty	M
	da Cruz, 2018 [34]	DED	Symptoms; signs	Japanese criteria^q	Psoriasis patients 43 Controls 86	Psoriasis patients 7 Controls 3	Psoriasis patients 16.3, 95%CI* 6.8, 30.7 Controls 3.5, 95%CI* 0.7, 9.9	Period: October 2013 to August 2014	¶ n.r; † n.r.; ‡ n.r.	H
				Symptoms (questionnaire)^d	Psoriasis patients 43 Controls 86	Psoriasis patients 17 Controls 16	Psoriasis patients 39.5, 95%CI* 24.9, 55.6 Controls 18.6, 95%CI* 11.0, 28.5
				TBUT^e	Psoriasis patients 43 Controls 86	Psoriasis patients 23 Controls 35	Psoriasis patients 53.5, 95%CI* 37.7, 68.8 Controls 40.7, 95%CI* 30.2, 51.8
				Schirmer I test^r	Psoriasis patients 43 Controls 86	Psoriasis patients 6 Controls 5	Psoriasis patients 13.9, 95%CI* 5.3, 27.9 Controls 5.8, 95%CI* 1.9, 13.1
				Rose Bengal staining^s	Psoriasis patients 43 Controls 86	Psoriasis patients 23 Controls 25	Psoriasis patients 53.5, 95%CI* 37.7, 68.8 Controls 29.1, 95%CI* 19.8, 39.9
	Surmacz, 2021 [31]	DED	Signs	Schirmer I test^t	135	60	44.4, 95% CI* 35.9, 53.2	Point: n.r	¶ n.r.; † Altered Schirmer's test vs normal and altered TBUT vs normal, age, sex, race/ethnicity, medical comorbidities, medication use, others—smoking, BMI, body composition, OSDI; ‡ n.r.	H
	Surmacz, 2021 [31]	DED	Signs	TBUT^e	135	108	80, 95%CI* 72.3, 86.4	Point: n.r		H
	De Freitas, 2021 [38]	DED	Signs	Schirmer I test^l	Diabetes patients 120	Diabetes patients 46	Diabetes patients 38.3, 95%CI* 29.6, 47.7	Period: April 2018 to March 2019	¶ Severity of dry eye symptoms † Sex, age, medical comorbidities, medication use (metformin, insulin), Other– women at menopause, smoking status ‡ Age medical comorbidities, medication use (metformin, insulin)	H
	De Freitas, 2021 [38]	DED	Signs	Schirmer I test^l	Controls 120	Controls 30	Controls 25, 95%CI* 17.6, 33.7	Period: April 2018 to March 2019		H

CI Confidence interval; H High, MGD Meibomian gland dysfunction, M Moderate, n.r. Not reported, SD standard deviation, ¶ Stratified by characteristic, † Characteristic included in a univariate analysis, ‡ Characteristic included in a multivariate analysis, * derived by binomial "exact" calculation (https://sample-size.net/confidence-interval-proportion/); § one-sided 97.5% confidence interval, a – 'Yes' answer to the question “Have you ever been diagnosed (by a clinician) as having dry eye disease?”, b – Womens Health Study questionnaire: Evaluated using the following questions: “How often do your eyes feel dry? and “How often do your eyes feel irritated?”. Response options included “never”, “sometimes”, "often”, and “constantly”. Dry eye defined as the presence of severe symptoms, indicated by "constantly" or "often" response to BOTH questions, c – DEQ-5 score: 7–12 indicates mild to moderate symptoms of DE; > 12 indicates severe symptoms of DE, d – OSDI scale from 0 to 100: 0–12 are considered normal, 13–22 light dry eye symptoms, 23–32 moderate, and > 32 severe symptoms, e – TBUT ≤ 10 s, f – Oxford Schema fluorescein grade ≥ 1, g – Schirmer's I test with anaesthesia < 10 mm, h – Meibomian gland dysfunction stage 2 (Meibomian gland secretion, or “meibum”, quality was assessed in each of the 8 glands of the central third of the lower lid, on a 0–3 scale for each gland: 0 = clear meibum; 1 = cloudy meibum; 2 = cloudy with debris (granular); 3 = thick, like toothpaste. The expressibility of the meibum was assessed from 5 glands: 0 = all glands were expressible; 1 = 3–4 glands were expressible; 2 = 1–2 glands were expressible; 3 = no glands were expressible. Gland dysfunction was classified according to the score obtained: Stage 1 = minimally altered secretions: grade > 2 – < 4; expressiveness: 1. Stage 2 = moderately altered secretions: grade > 4 – < 8; expressiveness: 1. Stage 3 = moderately altered secretions: grade > 8 – < 13; expressiveness: 2. Stage 4 = severely altered secretions: grade > 13; expressiveness: 3), i – Ocular surface damage (fluorescein and Lissamine green) grade ≥ 1, j – Schirmer I test with anesthesia ≤ 5 mm, k – VDT-related symptoms included: soreness, itchiness, pain, dryness, foreign body sensation, redness, visual fatigue, and blurry vision. The frequencies of these symptoms were categorized using a frequency scale in five categories: never, rarely, sometimes, often, and always, and they were graded from 1 (never) to 5 (always) in relation to each answer, l – Schirmer I test without anesthesia ≤ 10 mm, m – TBUT ≤ 5 s, n – Oxford schema corneal fluorescein grade ≥ 2, o – Schirmer I test without anesthesia ≤ 5 mm, p – Meibum gland quality ≥ 2, q – Dry eyes were diagnosed according to Japanese criteria, which required that patients had clinical symptoms and at least two positive results from among the Schirmer I test, the TBUT test, the rose bengal test, and the presence of keratitis. Patients who met only two criteria were classified as having probable dry eyes, r – Schirmer I test without anesthesia ≤ 10 mm / 5 min, s – Rose bengal test, scored from 0–9, considered abnormal if value > 3, t – Schirmer I test without anesthesia ≤ 5 mm in ≥ 1 eye

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