Dry eye disease in the elderly in a French population-based study (the Montrachet study: Maculopathy, Optic Nerve, nuTRition, neurovAsCular and HEarT diseases): Prevalence and associated factors

Purpose: To estimate the prevalence of dry eye disease (DED) in the elderly and to describe systemic and ocular factors associated with DED in a population-based study, the Montrachet (Maculopathy Optic Nerve nuTRition neurovAsCular and HEarT diseases) study.

Methods: Dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. A self-reported history of dry eye symptoms and artificial tear use were also recorded. Every participant underwent an ophthalmic evaluation, which included the Schirmer test without anesthesia (Schirmer I), tear film breakup time (TFBUT) measurement, and fluorescein corneal staining evaluation.

Results: A total of 1045 subjects were included in the study. The mean age was 82.2 ± 3.8 years. The prevalence of DED according to symptoms, signs, or both was 34.4% [95% confidence interval ({CI)} 31.5-37.2], 34.5% [95% CI 31.6-37.3] and 13.0% [95% CI 10.9-15.0], respectively. Compared with men, women were more likely to self-report DED and artificial tear use, more often displayed an OSDI >22, and more often suffered from subjective and definite DED. In multivariate analysis, associated factors with definite DED were an educational level of short secondary school (to age 15 years), best-corrected visual acuity <20/60, dark iris color, systemic hypertension, and anxiolytic agent and antihistamine eye drop use.

Conclusion: Dry eye disease is a major ophthalmologic condition with a high prevalence among the elderly. We report well-documented factors associated with DED and new associations deserving further investigation.