Abstract
Introduction
The aim of this study was to investigate the clinical characteristics and practice pattern of patients with dry eye disease (DED) in eye clinics across Japan.
Methods
A multi-center, cross-sectional study was conducted among patients with DED who visited eye clinics in Japan. Subjective symptoms, patient’s background, ocular surface features, and tear function were evaluated. Main outcome measures were tear break-up time (TBUT), Schirmer I value, kerato-conjunctival staining score, and dry eye symptom questionnaire score.
Results
Initially, 463 subjects were enrolled, and 449 cases (63 male and 386 female; mean age, 62.6 ± 15.7 years) were included in the final analysis. Overall, 94.9% of patients had a shortened TBUT (≤5 s), and 54.6% had an aqueous tear deficiency (Schirmer I value ≤5 mm). The most prevalent subtype of dry eye was aqueous-deficient dry eye, which was present in 35.0% of all patients, followed by short-BUT-type dry eye, which was seen in 26.7%.
Conclusion
The two most common DED subtypes were aqueous-deficient and short-BUT-type dry eye. Shortened TBUT is the most common feature of dry eye, regardless of subtype. The current treatment choice mainly consisted of hyaluronic acid, two novel mucin secretagogues, diquafosol and rebamipide, and steroidal eye drops.
Trial Registration: University Hospital Medical Information Network: UMIN (registries no. UMIN 000015890).
Funding: Japan Dry Eye Society, Tokyo, Japan, and Santen Pharmaceutical Co., Ltd., Osaka, Japan.
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References
The Definition and Classification of Dry Eye Disease: report of the Definition and Classification Subcommittee of the International Dry Eye Work Shop. Ocul Surf. 2007;5:75–92.
Shimazaki J, Tsubota K, Kinoshita S, et al. Definition and diagnosis of dry eye. Atarashii Ganka (in Japanese). 2007;4:181–4.
Uchino M, Yokoi N, Uchino Y, et al. Prevalence of dry eye disease and its risk factors in visual display terminal users: the Osaka study. Am J Ophthalmol. 2013;156:759–66.
Lee AJ, Saw SM, Gazzard G, Koh D, Widjaja D, Tan DT. Prevalence and risk factors associated with dry eye symptoms: a population based study in Indonesia. Br J Ophthalmol. 2002;86:1347–51.
Moss SE, Klein R, Klein BE. Long-term incidence of dry eye in an older population. Optom Vis Sci. 2008;85:668–74.
Schaumberg DA, Sullivan DA, Buring JE, Dana MR. Prevalence of dry eye syndrome among US women. Am J Ophthalmol. 2003;136:318–26.
Ahn JM, Lee SH, Rim TH, et al. Prevalence of and risk factors associated with dry eye: the Korea National Health and Nutrition Examination Survey 2010–2011. Am J Ophthalmol. 2014;158:1205–14.
Shimmura S, Shimazaki J, Tsubota K. Results of a population-based questionnaire on the symptoms and lifestyles associated with dry eye. Cornea. 1999;18:408–11.
Pflugfelder SC. Prevalence, burden, and pharmacoeconomics of dry eye disease. Am J Managed Care. 2008;14:S102–6.
Yazdani C, McLaughlin T, Smeeding JE, Walt J. Prevalence of treated dry eye disease in a managed care population. Clin Ther. 2001;23:1672–82.
Um SB, Kim NH, Lee HK, Song JS, Kim HC. Spatial epidemiology of dry eye disease: findings from South Korea. Int J Health Geogr. 2014;15(13):31.
Tesón M, López-Miguel A, Neves H, et al. Influence of climate on clinical diagnostic dry eye tests: pilot study. Optom Vis Sci. 2015;92(9):e284–9.
Albietz JM. Prevalence of dry eye subtypes in clinical optometry practice. Optom Vis Sci. 2000;77:357–63.
Rege A, Kulkarni V, Puthran N, Khandgave T. A clinical study of subtype-based prevalence of dry eye. J Clin Diagn Res. 2013;7:2207–10.
Lemp MA, Crews LA, Bron AJ, et al. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31:472–8.
Lemp MA. Report of the national eye institute/industry workshop on clinical trials in dry eyes. CLAO J. 1995;21:221–32.
van Bijsterveld OP. Diagnostic tests in the Sicca syndrome. Arch Ophthalmol. 1969;82:10–4.
Amano S. MGD Working Group. Definition and diagnostic criteria for meibomian gland dysfunction. Atarashii Ganka (in Japanese). 2010;27:627–31.
Sakane Y, Yamaguchi M, Yokoi N, et al. Development and validation of the Dry Eye-Related Quality-of-Life Score questionnaire. JAMA Ophthalmol. 2013;131:1331–8.
Yokoi N, Uchino M, Uchino Y, et al. Importance of tear film instability in dry eye disease in office workers using visual display terminals: the Osaka study. Am J Ophthalmol. 2015;159:748–54.
Lienert JP, Tarko L, Uchino M, et al. Long-term natural history of dry eye disease from the patient’s perspective. Ophthalmology. 2016;123:425–33.
Tong L, Chaurasia SS, Mehta JS, Beuerman RW. Screening for meibomian gland disease: its relation to dry eye subtypes and symptoms in a tertiary referral clinic in Singapore. Invest Ophthalmol Vis Sci. 2010;51:3449–54.
Yamaguchi M, Nishijima T, Shimazaki J, et al. Clinical usefulness of diquafosol for real-world dry eye patients: a prospective, open-label, non-interventional, observational study. Adv Ther. 2014;31:1169–81.
Yamaguchi M, Nishijima T, Shimazaki J, et al. Real-world assessment of diquafosol in dry eye patients with risk factors such as contact lens, meibomian gland dysfunction, and conjunctivochalasis: subgroup analysis from a prospective observational study. Clin Ophthalmol. 2015;9:2251–6.
Mizuno Y, Yamada M, Miyake Y, Dry Eye Survey Group of the National Hospital Organization of Japan. Association between clinical diagnostic tests and health-related quality of life surveys in patients with dry eye syndrome. Jpn J Ophthalmol. 2010;54:259–65.
Song JS, Hyon JY, Lee D, et al. Current practice pattern for dry eye patients in South Korea: a multicenter study. Korean J Ophthalmol. 2014;28:115–21.
Acknowledgements
This study and publication charges were funded by the Japan Dry Eye Society, Tokyo, Japan, and Santen Pharmaceutical Co., Ltd., Osaka, Japan.
The present study was conducted by the joint study organization of the Dry Eye Society and Santen Pharmaceutical Co., Ltd. Both organizations contributed to the creation of documents including the study protocol, management of study progress, and provided information and support to the study sites, evaluation of the data analysis, disclosure of the outcome of the study, and entry/update of the present study in the public registration system.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.
The DECS-J Study Group: The following individuals participated in the study. Central Unit: Motoko Kawashima, Masakazu Yamada, Kazuhisa Suwaki, Chika Shigeyasu, Yoshimune Hiratsuka, Norihiko Yokoi, Kazuo Tsubota. Study group investigators and clinical sites: Yoshitsugu Tagawa (Kitaichijo Tagawa Eye Clinic, Sapporo, Hokkaido, Japan), Seika Den (Akasaka Tokyu Shimazaki Eye Clinic, Tokyo, Japan), Miki Iwasaki (Ryogoku Eye Clinic, Tokyo, Japan), Hiroshi Saito (Saito Eye Clinic, Saitama, Japan), Reiko Ishida (Ishida Clinic, Shizuoka, Japan), Aoi Komuro (Shijo-karasuma Komuro Eye Clinic, Kyoto, Japan), Naoki Iwasaki (Iwasaki Eye Clinic, Osaka, Japan), Harue Matsumoto (Matsumoto Eye Clinic, Tokushima, Japan), Tomoko Goto (Hanamizuki Eye Clinic, Ehime, Japan), Atsuko Kiyosawa (Kiyosawa Eye Clinic, Fukuoka, Japan).
Disclosures
Kazuhisa Suwaki: employee of Santen Pharmaceutical Co., Ltd.
Masakazu Yamada: consultant for Otsuka Pharmaceutical Co. Ltd, and Johnson & Johnson Vision Care Co.
Norihiko Yokoi: consultant for Kissei Co., Ltd., and Rohto Co., Ltd.
Kazuo Tsubota: consultant, speaker’s bureau member and grant recipient of Santen Pharmaceutical Co., Ltd.; speaker’s bureau member and grant recipient of Otsuka Pharmaceutical Co., Ltd.
Motoko Kawashima, Chika Shigeyasu, Yoshimune Hiratsuka, and Miki Uchino have nothing to disclose.
Compliance with Ethics Guidelines
This study protocol was approved by the Institutional Review Board of Clinical Study of Ryogoku Eye Clinic Tokyo, Japan. This study was conducted in accordance with the guidelines of the World Medical Association Declaration of Helsinki and Ethical Guidelines for Medical and Health Research involving Human Subjects in Japan. The subjects received a full explanation of the procedures and provided their written informed consent for participation prior to inclusion in the study. The study was registered in the public registration system [University Hospital Medical Information Network: UMIN (Registries No. UMIN 000015890)].
Data Availability
The data sets during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Kawashima, M., Yamada, M., Suwaki, K. et al. A Clinic-based Survey of Clinical Characteristics and Practice Pattern of Dry Eye in Japan. Adv Ther 34, 732–743 (2017). https://doi.org/10.1007/s12325-017-0487-x
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DOI: https://doi.org/10.1007/s12325-017-0487-x