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Meta-Analysis
. 2022 Dec 1;140(12):1181-1192.
doi: 10.1001/jamaophthalmol.2022.4394.

Prevalence and Incidence of Dry Eye and Meibomian Gland Dysfunction in the United States: A Systematic Review and Meta-analysis

Paul McCann  1 , Alison G Abraham  1   2 , Adhuna Mukhopadhyay  2 , Kanella Panagiotopoulou  3 , Hongan Chen  1 , Thanitsara Rittiphairoj  1 , Darren G Gregory  1 , Scott G Hauswirth  1 , Cristos Ifantides  1 , Riaz Qureshi  1   2 , Su-Hsun Liu  1   2 , Ian J Saldanha  4   5 , Tianjing Li  1   2
Affiliations
Meta-Analysis

Prevalence and Incidence of Dry Eye and Meibomian Gland Dysfunction in the United States: A Systematic Review and Meta-analysis

Paul McCann et al. JAMA Ophthalmol. .

Abstract

Importance: Dry eye is a common clinical manifestation, a leading cause of eye clinic visits, and a significant societal and personal economic burden in the United States. Meibomian gland dysfunction (MGD) is a major cause of evaporative dry eye.

Objective: To conduct a systematic review and meta-analysis to obtain updated estimates of the prevalence and incidence of dry eye and MGD in the United States.

Data sources: Ovid MEDLINE and Embase.

Study selection: A search conducted on August 16, 2021, identified studies published between January 1, 2010, and August 16, 2021, with no restrictions regarding participant age or language of publication. Case reports, case series, case-control studies, and interventional studies were excluded.

Data extraction and synthesis: The conduct of review followed a protocol registered on PROSPERO (CRD42021256934). PRISMA guidelines were followed for reporting. Joanna Briggs Institute and Newcastle Ottawa Scale tools were used to assess risk of bias. Data extraction was conducted by 1 reviewer and verified by another for accuracy. Prevalence of dry eye and MGD were combined in separate meta-analyses using random-effects models.

Main outcomes and measures: Prevalence and incidence of dry eye and MGD in the United States. Summary estimates from meta-analysis of dry eye and MGD prevalence with 95% CI and 95% prediction intervals (95% PI).

Results: Thirteen studies were included in the systematic review. Dry eye prevalence was reported by 10 studies, dry eye incidence by 2 studies, and MGD prevalence by 3 studies. Meta-analysis estimated a dry eye prevalence of 8.1% (95% CI, 4.9%-13.1%; 95% PI, 0%-98.9%; 3 studies; 9 808 758 participants) and MGD prevalence of 21.2% (95% CI, 7.2%-48.3%; 95% PI, 0%-100%; 3 studies; 19 648 participants). Dry eye incidence was 3.5% in a population 18 years and older and 7.8% in a population aged 68 years and older. No studies reported MGD incidence.

Conclusions and relevance: This systematic review and meta-analysis demonstrated uncertainty about the prevalence and incidence of dry eye and MGD in the United States. Population-based epidemiological studies that use consistent and validated definitions of dry eye and MGD are needed for higher-certainty estimates of dry eye and MGD prevalence and incidence in the United States.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Abraham reported personal fees from Implementation Group, Hirslanden Klinik, and Elsevier outside the submitted work. Dr Hauswirth reported consultant and personal fees from Allergan, Kala Pharmaceuticals, Ocular Therapeutix, Sun Pharma, Dompe, Horizon Pharma, Oyster Point, Sight Sciences, Science Based Health, and Thea Pharma; grants from Dompe; and nonfinancial support from TearRestore outside the submitted work. Dr Ifantides reported personal fees from Alcon, Johnson & Johnson, Tarsus, and Allergan outside the submitted work and having a patent pending for 3-dimensional–printed eye glasses for dry eye disease. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Meta-analysis of the Prevalence of Dry Eye in the US Population
A, Prevalence reported in studies without high risk of bias and judged to be representative of the general population. B, Prevalence reported in studies without high risk of bias and judged to be representative of the general population plus Lee et al (a nationwide Veterans Affairs health system database study with a 95.1% male population). C, Prevalence reported in studies without high risk of bias and judged to be representative of the general population plus Lee et al (a nationwide Veterans Affairs health system database study with a 95.1% male population) and Chang et al (a single-institution clinic-based study that used consecutive enrollment from a comprehensive eye clinic in Miami, Florida).
Figure 2.
Figure 2.. Meta-analysis of the Prevalence of Meibomian Gland Dysfunction in the US Population
See this image and copyright information in PMC

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