The epidemiology of dry eye disease in the UK: The Aston dry eye study

Purpose: Cross-sectional studies on dry eye disease (DED) have relied on different diagnoses hindering conclu-sions about the disease epidemiology. This study offers an insight into DED epidemiology in the UK using prior and recent diagnostic recommendations. Methods: Study participants comprised 282 volunteers from Birmingham, UK (median 40 years, range 18-88 years, 56% females). DED was defined by the Tear Film Ocular Surface Dry Eye Workshop II (TFOS DEWS II) criteria, based on a positive symptom score with the Dry Eye Questionnaire (DEQ-5) and Ocular Surface Disease Index (OSDI), and one of the following homeostasis markers: non-invasive tear break-up time of < 10 s (Oculus Keratograph 5M); the highest osmolarity value of >= 308 mOsm/L among eyes or an interocular osmolarity difference of > 8 mOsm/L (TearLab Osmolarity System); or > 5 corneal spots, >9 conjunctival spots or lower/ upper lid-wiper-epitheliopathy staining of >= 2 mm length and >= 25% width (Oculus Keratograph 5 M). In addition, the Women's Health Study (WHS) criteria, based on symptoms or a prior dry eye diagnosis, was assessed. DED risk factors were gathered using a self-administered questionnaire.Results: DED prevalence by the TFOS DEWS II criteria was 32.1% (95% confidence interval 25.5-37.7% and 29.5% (95% confidence interval 24.4-35.1% by the WHS criteria. Female sex, systemic and/or ocular health conditions, short sleep duration and prolonged outdoor leisure time spent were significant DED risk factors (p <= 0.05). Conclusions: Approximately one-third of the adult UK population have DED, aligning with the prevalence re-ported in multiple counties globally. Female sex, systemic/ocular health conditions, short sleep duration and prolonged outdoor leisure time are positive predictors of DED.