Prevalence and Risk Factors for Dry Eye Disease in Chinese Type II Diabetics

Abstract

Purpose: (100 words) Dry eye syndrome (DES) is a major cause of ocular morbidities worldwide. Diabetes mellitus is associated with many ocular complications including DES. However, the prevalence of DES amongst Chinese diabetic patients in Hong Kong is unknown. This observational study aims to estimate the prevalence of DES in the Chinese diabetic population. Secondary objectives involve examining the association(s) between dry eye status and diabetes-related clinical parameters. Setting: (50 words) A cross-sectional observational study was conducted in Hong Kong, at the Lo Fong Siu Po Eye Centre (Grantham Hospital), in close collaboration with the K.K. Leung Diabetes Centre (Queen Mary Hospital), and The University of Hong Kong from January to March 2017. Methods: (100 words) Eighty Chinese type 2 diabetes mellitus patients were recruited. Dry eye assessment was done with the Oculus Keratograph 5M to evaluate tear meniscus height (TMH), non-invasive tear break-up time (NITBUT), and bulbar redness (BR). Ocular symptoms were evaluated via the Ocular Surface Disease Index (OSDI), Symptom Assessment iN Dry Eye (SANDE), and Standard Patient Evaluation of Eye Dryness (SPEED). We adopted the Asia Dry Eye Society’s definition of DES; having an OSDI ≥ 13 and NITBUT ≤ 5 seconds. Diabetes-related parameters were obtained from questionnaires or retrieved from electronic patient records. All statistical analyses were performed using SPSS Statistics software. Results: (100 words) The prevalence of DES was 18% (95% CI: 8-28%) among 80 Chinese diabetic subjects (mean age 63.75 ± 10.95 years, female 44%). Ocular surface evaluation revealed significant negative Pearson correlations between HbA1c and NITBUT (P = 0.010), duration of diabetes and NITBUT (P = 0.016), and positive correlations between HbA1c and OSDI score (P = 0.041). There were no significant correlations between OSDI and SPEED or SANDE scores. Conclusions: (100 words) There is a higher prevalence of DES amongst those suffering from diabetes in comparison to the general Chinese population in Hong Kong. Both increased serum HbA1c, and longer duration of diabetes were associated with reduced tear break up time. Higher serum HbA1c was also associated with a higher OSDI score. From this, we conclude that DES is a prevalent diabetic complication in the Hong Kong Chinese population. As poor glycaemic control is associated with worse dry eye status, more attention should be focused on glycaemic control to improve management of diabetes-related DES.