Elsevier

The Ocular Surface

Volume 16, Issue 2, April 2018, Pages 242-248
The Ocular Surface

Original Research
Sex differences in clinical characteristics of dry eye disease

https://doi.org/10.1016/j.jtos.2018.01.001Get rights and content

Abstract

Purpose

To investigate the role of sex on the symptomatology of DED and on the associations between symptoms and signs.

Methods

A cross-sectional study was used including 755 dry eye patients from the Groningen Longitudinal Sicca Study (GLOSSY cohort). Patient symptoms were assessed by the Ocular Surface Disease Index (OSDI) questionnaire and dry eye signs by the six most commonly used tests. Patients were divided in groups based on overall severity of signs and within these groups total and specific symptoms were compared by sex. Sex differences in Spearman correlation between symptoms and signs were calculated.

Results

Women had higher total symptom scores than men in both the mild (33.8 vs 24.7, P = .01) and moderate signs groups (38.3 vs 28.0, P < .005), but this difference was less apparent in the severe signs group (40.4 vs 37.2, P = .33). Independent of severity of signs, women consistently reported more light sensitivity than men (P < .01 in all groups). The correlation between symptoms and overall severity of signs score was significantly lower in women (ρ = 0.11 vs ρ = 0.33 in men, P = .01), with clearest differences between women and men in correlations with Schirmer (ρ = 0.01 vs ρ = -0.21, P = .03) and TFBUT (ρ = -0.08 vs ρ = -0.30, P = .02).

Conclusions

This large clinical study has shown that sex has a large influence on the symptomatology of DED, with significantly higher symptom scores and lower correlation between symptoms and signs in women compared to men. These findings are of importance in clinical practice and in conducting research into DED.

Introduction

The importance of sex and gender disparities and the need to account for sex as a biological variable is being increasingly emphasized in medical research [1]. In Ophthalmology there are notable sex differences in many traits and diseases, but very little is known about root causes to enable design and implementation of diagnostic, preventive and treatment strategies. [2] Dry eye disease (DED) is no exception, as numerous epidemiological studies have shown that DED is far more prevalent in women than in men and biological studies have shown that sex has a major influence on the regulation of the ocular surface and adnexa [3,4]. Different underlying mechanisms of pathophysiology have been proposed, such as a possible important role for sex steroids and other hormone imbalances in women [4]. However, despite all the epidemiological and biological studies, there is still a surprisingly lack of knowledge about the influence of sex in clinical characteristics of DED. To our knowledge, only one study has reported sex differences in total symptoms of DED, showing more symptoms in women [5]. However, there have been no reported studies investigating sex differences in clinical characteristics of DED, including both symptoms and signs and their correlation. Indeed, the recently published TFOS DEWS II report on Sex, gender and hormones [4] advocated the need for further studies to clarify the precise nature and extent of sex and gender effects on DED, with a special need for epidemiological studies using data on both signs and symptoms, and for studies investigating differences in diagnostic tests between men and women. Therefore, this study aimed to explore the role of sex in the clinical characteristics of dry eye patients, using a large tertiary dry eye patient cohort. We investigated sex differences in both the symptomatology of DED and the association between DED symptoms and the most commonly tested signs in clinic.

Section snippets

Study sample

The GLOSSY (Groningen LOngitudinal Sicca StudY) cohort is a clinic-based cohort of dry eye patients from the tertiary dry eye clinic at the University Medical Center Groningen in the Netherlands. General and ophthalmic medical history, dry eye symptoms, dry eye test results using standardized methods, and dry eye therapies have been recorded longitudinally since September 2014, resulting in a clinical cohort with data on approximately 1500 patient visits a year. The University Medical Center

Results

The first consecutive 755 DED patients from the GLOSSY cohort were included. The majority was female (n = 607, 80.4%) and the mean age was 56.1 (standard deviation 15.7) years. Table 1 shows the demographics and the prevalence of self-reported comorbidities, stratified by sex. The prevalence of chronic pain syndromes, Sjögren syndrome, osteoarthritis, the presence of any allergy, and thyroid disease were all higher in women, consistent with distribution of these diseases in the general

Discussion

To our knowledge, this study is the first clinical study specifically looking at sex differences in clinical characteristics of DED patients. Our results showed that, even when corrected for severity of signs, female dry eye patients tend to be more symptomatic than men, especially when only mild or moderate signs are present. An uncomfortable feeling with environmental triggers like wind and air-conditioning, and particularly light sensitivity are symptoms that were identified as female

Funding

The Gratama Stichting of the University of Groningen provided financial support in the form of grant funding. The sponsor had no role in the design or conduct of the study.

Financial support

The study was supported by a grant from the Gratama Stichting, University of Groningen. The funding organization had no role in the design or conduct of this research.

Conflicts of interest

None for any of the authors. The authors have no commercial or proprietary in any concept or product described in this article.

Acknowledgments

The authors thank Luuk Mooibroek for his extensive work in maintaining the database of the GLOSSY cohort.

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