Prevalence of Symptomatic Dry Eye Disease in an Urban Chinese Community: A Cross-sectional Population-based Study Venice SW LI, Sophie SL YEOW, Jeffrey.

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Prevalence of Symptomatic Dry Eye Disease in an Urban Chinese Community: A Cross-sectional Population-based Study Venice SW LI, Sophie SL YEOW, Jeffrey MY LO, Kendrick C SHIH, Jimmy SM LAI, Alex LK NG Faculty of Medicine, The Chinese University of Hong Kong Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong ESCRS Lisbon 2017 I Have No Financial Interest to Disclose

Background Dry Eye Disease: multifactorial disease characterized by unstable tear film causing a variety of symptoms and/or visual impairment, potentially accompanied by ocular surface damage (Tsubota et al, 2017) Ocular Surface Disease Index Questionnaire (OSDI) and Symptom Assessment iN Dry Eye Questionnaire (SANDE) questionnaires commonly used in assessment of symptoms Previous studies show significant correlation and negligible score differences between OSDI and SANDE (Amparo et al, 2015) Tsubota, K., Yokoi, N., Shimazaki, J., Watanabe, H., Dogru, M., Yamada, M., . . . Yamaguchi, M. (2017). New Perspectives on Dry Eye Definition and Diagnosis: A Consensus Report by the Asia Dry Eye Society. The Ocular Surface,15(1), 65-76. Amparo, F., Schaumberg, D. A., & Dana, R. (2015). Comparison of two questionnaires for dry eye symptom assessment: the Ocular Surface Disease Index and the Symptom Assessment in Dry Eye. Ophthalmology, 122(7), 1498-1503.

Aim Primary outcome: 1. Prevalence and severity of dry eye symptoms and signs in a population-based sample in Hong Kong 2. Prevalence of dry eye syndrome by gender and age in this group Secondary outcome: 1. Correlation between OSDI/SANDE and tear meniscus height (TMH) 2. Correlation between OSDI and SANDE

Methodology Cross-sectional study conducted in a community-based health promotion program in Hong Kong, over 2 days in November 2016 276 subjects screened Dry eye symptoms evaluated by OSDI & SANDE questionnaires DED Definition: OSDI ≥ 13 (Asia Dry Eye Society) Tear meniscus height (TMH) measured with Oculus Keratograph 5M DED Definition: TMH <0.25 mm (American Academy of Ophthalmology)

Results 55 male (19.9%), 221 female (71.1%). Mean age 58.9 years ± 18.4 27.5% of subjects had symptomatic dry eye disease according to OSDI Females significantly associated with higher OSDI scores Age (<60 vs ≥ 60) not significant risk factor for higher OSDI score No significant correlation between OSDI score, SANDE score & TMH Total Male Female Mean SANDE Score 3.06 ±2.57 2.26 ±2.14 3.26 ±2.63 Mean OSDI Score 9.22 ±7.91 6.84 ±6.49 9.82 ±8.13 Mean Tear Meniscus Height 0.254 mm ±0.09 0.281 mm ±0.09 0.248 mm ±0.09

Conclusion Symptomatic dry eye disease is prevalent in urban Chinese community, significantly more severe in females OSDI was convenient in evaluating dry eye symptoms in our locality OSDI fails to exclude patients with probable neuropathic pain without objective dry eye signs Our population had difficulty in using SANDE questionnaire Cultural differences in interpretation of visual analog scale may explain why SANDE and OSDI did not correlate in our population Amparo, F., Schaumberg, D. A., & Dana, R. (2015). Comparison of two questionnaires for dry eye symptom assessment: the Ocular Surface Disease Index and the Symptom Assessment in Dry Eye. Ophthalmology, 122(7), 1498-1503.