PURPOSE: To evaluate the incidence of symptomatic dry eye disease (SDED) and associated risk factors in a well-characterized cohort of ethnic Malays in Singapore.
METHODS: We included 1682 participants (mean age [SD]: 57 [10]years; 55.4% female) without SDED from the Singapore Malay Eye Study (SiMES), a population-based longitudinal study with baseline examination (SiMES-1) conducted between 2004 and 2006, and follow-up examination (SiMES-2) conducted between 2010 and 2013. SDED was considered to be present if a participant answered "often" or "all the time" to any of the six questions from the Salisbury Eye Evaluation Study dry eye questionnaire. Age-standardized incidence of SDED was calculated as the crude 6-year cumulative incidence standardized to Singapore's population census. Gender-stratified multivariable log-binomial regression models were utilized to determine the independent risk factors of incident SDED.
RESULTS: At the 6-year follow-up, 86 of 1682 participants had developed SDED, which was equivalent to an age-standardized 6-year incidence of 5.1% (95% CI 4.1-6.4%). There were no differences in the incidence of SDED between men and women (P = 0.9). Multivariable models revealed that presence of glaucoma and poorer self-rated health were independently associated with incident SDED in men (P = 0.003 and 0.03, respectively), while contact lens wear (P = 0.002), history of thyroid disease (P = 0.03), and having had cataract surgery (P = 0.02) were predictive of incident SDED in women.
CONCLUSION: One in twenty adult Malays developed SDED over a 6-year period. Risk factors for incident SDED were different between men and women. Future studies and public health interventions should consider this gender-specific difference in risk factors.
Two hundred outpatients (115 females and 85 males) attending the University Malaya Medical Center (UMMC) eye clinic, aged 20 years and above and without any ocular surface disorder were recruited for this study. Their tear film status was determined subjectively by their symptoms and quantitatively by the cotton thread test, Schirmer's test, marginal tear film meniscus assessment, fluorescein corneal staining and tear break-up time. Dry eye was considered present if at least one symptom was experienced often or always, within the past 3 months. Dry eye was also considered present if one of these tests was positive; Schirmer's test < 5 mm, Phenol red thread (PRT) test < 10 mm and tear film breakup time (BUT) < 8 seconds. The prevalence of dry eye in this sample population as defined by presence of symptoms and an abnormal test result is 14.5%. Presence of dry eye as detected by clinical testing is higher in the Chinese race (p < 0.01), in the group 40-59 years (p = 0.024). There is no difference between females and males. A lower BUT score was more strongly associated with presence of dry eye symptoms (p = 0.02). Elderly patients have a lower BUT and Schirmer's score. There is lack of agreement between PRT and Schirmer's test, although both are measures of tear quantity.
Study site: Eye clinic, University Malaya Medical Center (UMMC), Kuala Lumpur, Malaysia
The aim of the study was to determine the spectrum of clinical ocular involvement in patients with inactive systemic lupus erythematosus (SLE) who have no ocular symptoms. Patients with a diagnosis of SLE based on the 1982 revised American College of Rheumatology criteria and with no ocular complaints were recruited from the SLE clinic. Clinical data regarding their systemic disease and disease activity were recorded and a full ophthalmic examination carried out. 52 patients of mixed ethnicity comprising of 75% Chinese, 19% Malays and 6% Indian patients were recruited. Of these, 51 (98%) were female with a mean age of 34+/-11 (range 16-74 y). 16 (31%) patients had dry eyes while corticosteroid induced glaucoma and cataract was detected in 1 (2%) and 7 (14%) patients, respectively. No patients were found to have sight-threatening ocular conditions such as cotton wool spots, vasculitis, optic neuropathy or uveitis. Patients with clinically inactive disease were found not to have sight-threatening ocular diseases that are known to be associated with SLE. Although they have no ocular complaints, nearly one-third of these patients have dry eyes. Ocular examination may be unnecessary when the disease is clinically inactive and in the absence of ocular symptoms.
Study site: SLE clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia