Sex differences in clinical characteristics of dry eye disease

Vehof, Jelle; Smitt-Kamminga, Nicole Sillevis; Nibourg, Simone A.; Hammond, Christopher J.

doi:10.1016/j.jtos.2018.01.001

Cited by 58 publications

(43 citation statements)

References 29 publications

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“…Female participants reported higher OSDI scores at earlier age than men. Although sex-based differences in OSDI scores have been reported previously in ocular surface diseases, 22,23 our results highlighted a sex-specific suscepti-FIGURE 2. Clinical assessments of ocular surface system function according to male (left side) and female (right side) subgroups.…”

Section: Discussionsupporting

confidence: 45%

InflammAging at Ocular Surface: Clinical and Biomolecular Analyses in Healthy Volunteers

Zazzo

Micera

Coassin

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To assess the ocular surface in volunteers who consider themselves as healthy, in order to evaluate how para-inflammatory mechanisms fail with age, and thus investigate the phenomenon of ''InflammAging.'' METHODS. In this observational prospective cohort study, volunteers were categorized into three groups according to age: young (19-40 years), middle-aged (41-60 years), and older adults (61-93 years). Clinical assessments included tear breakup time (T-BUT) and Schirmer test type I. Dry eye symptoms were evaluated by the Ocular Surface Disease Index (OSDI) questionnaire. Conjunctival mRNA and protein expression of intercellular adhesion molecule-1 (ICAM-1), MUC5AC, and IL-8 were measured by real-time PCR and immunofluorescence. RESULTS. A total of 82 volunteers (38 males and 44 females) were enrolled. T-BUT decreased significantly with increasing age (young: 11.13 6 0.18 seconds; middle-aged: 10.83 6 0.56 seconds; older: 9.00 6 1.00 seconds, P < 0.05). Schirmer test values decreased significantly with age (young: 20.6 6 1.0 mm; middle-aged: 19.2 6 1.2 mm; older: 16.0 6 1.1 mm, P < 0.05). OSDI scores increased with age in both groups, but they were substantially higher in women. Conjunctival expression of inflammatory markers ICAM-1, IL-8, and MUC5AC increased with age. CONCLUSIONS. Clinical signs, symptoms, and biomarkers of chronic inflammation increased with age in a cohort of volunteers who considered themselves healthy, indicating an agerelated progressive impairment of ocular surface system function.

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Section: Discussionsupporting

confidence: 45%

InflammAging at Ocular Surface: Clinical and Biomolecular Analyses in Healthy Volunteers

Zazzo

Micera

Coassin

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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“…26,27 However, because of our large sample size, the fact that we accounted for confounding effects of significant intersex differences in ocular surface and demographics, along with the strength and consistency observed in our results among all the dry eye questionnaires, argues that there is likely a difference in how pain sensitivity influences dry eye symptom between women and men, but additional work will be needed to better define this difference. If, as our study suggests, greater pain sensitivity is found to be more strongly associated with higher dry eye symptoms in women, it could help explain why Vehof et al 28 found that women had a significantly lower correlation coefficient in the association between signs and symptoms of DED compared with men (r = 0.11 vs. r = 0.33, respectively). Pain sensitivity could potentially be a more significant confounder in the association between signs and symptoms for women compared with men.…”

Section: Discussionmentioning

confidence: 54%

Sex Disparity in How Pain Sensitivity Influences Dry Eye Symptoms

Lin

2019

Cornea

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Purpose: Women have a higher dry eye disease prevalence compared with men, although only relatively minor differences in the ocular surface have been observed. Interestingly, a sex difference in pain sensitivity is known, and recent research suggests that pain sensitivity is associated with dry eye symptoms. This study attempts to discern whether the association between pain sensitivity and dry eye symptoms varies between women and men. Methods: In this prospective cross-sectional study, subjects were seen for one visit where they were asked to fill out a set of questionnaires consisting of the Pain Sensitivity Questionnaire, Ocular Surface Disease Index (OSDI), and other dry eye questionnaires. This was followed by an ocular surface assessment on both eyes. Results: Two hundred eighty-seven subjects (194 women, 93 men) completed the study. Intersex differences in the ocular surface were noted. Even after accounting for these differences, an interaction effect between sex and Pain Sensitivity Questionnaire-minor score on dry eye symptoms was observed, with only women noting increased symptoms on the OSDI (P , 0.005) and other dry eye questionnaires (P values ranging from 0.01 to ,0.005) with greater pain sensitivity. After controlling for other variables, women with the highest pain sensitivity had a 17-point higher OSDI score and greater symptoms, as reported by all the other dry questionnaires compared with their male counterparts. Conclusions: The role of pain sensitivity on dry eye symptoms appears to vary between women and men. This difference provides insight into why women have a significantly higher dry eye disease prevalence than men.

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“…Previous reports have suggested higher incidence of symptoms of dry eye disease among female subjects, with significantly higher symptom scores and lower correlation between symptoms and signs as compared to males. 77 , 89 Females are represented in our cohort in >2.5:1 ratio to males suggesting that there may be greater incidence, assuming the population undergoing refractive surgery is split equally between the sexes. The PROWL studies were 20% female in the military cohort and 54% female in the civilian cohort.…”

Section: Discussionmentioning

confidence: 99%