Dry Eye Disease in the Middle East and Northern Africa: A Position Paper on the Current State and Unmet Needs

In the Middle East and Northern Africa (MENA), dry eye disease (DED) is often misdiagnosed or overlooked. This review summarizes a series of conversations with ophthalmologists in the region around a variety of climatic, lifestyle, and iatrogenic factors that contribute to specific features of DED in the MENA region. These considerations are further classified by patient lifestyle and surgical choices. All statements are based on discussions and formal voting to achieve consensus over three meetings. Overall, a deeper understanding of the disease characteristics of DED specific to MENA can better guide local eyecare practitioners on appropriate management and follow-up care. Additionally, population-based studies and patient and physician education on ocular surface diseases, together with the use of culturally appropriate and language-specific questionnaires can help ease the public health burden of DED in this region.

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

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.

The validity and reliability of the Arabic version of the ocular surface disease index (OSDI) questionnaire in a sample of the Gazan population: a study from Palestine

PURPOSE

To develop an Arabic version of OSDI for the Gazan population.

METHODS

A cross-sectional observational study was conducted using a convenience sample technique. The translation procedure included five stages: forward translation, revision of translation, backward translation, refinement of translation, and a final test of the pre-final version. The final sets of questionnaires were constructed using an online JotForm platform. The online platform was chosen to automatically calculate the questionnaire's final overall score. Overall, 260 participants were instructed to fill out the English and the Arab-OSDI version twice to conduct the reliability of the translated version and repeatability evaluation.

RESULTS

The mean age of the participants was 33.45 ± 11.74 years old. Cronbach's alpha for all items was greater than 0.80, except for the "blurred vision" and "deteriorating vision" items (0.77 and 0.74, respectively). The mean overall score difference between the English-OSDI and Arab-OSDI was 0.86 based on the Bland-Altman chart. For repeatability, no significant difference in the overall scores between the two repeats of the Arab-OSDI (p = 0.632). The Arab-OSDI overall score (sessions 1 and 2) has a clinical difference (bias) of 0.21. Using the varimax rotation method, only three factors (ocular symptoms, vision-related function, and environmental triggers) had eigenvalues greater than one in the structure of the Arab-OSDI.

CONCLUSION

The Arab-OSDI is an appropriate, reliable, and repeatable tool for the determination of dry eye symptoms, ocular discomfort, and quality of life in the Gazan population. This version could remove the language barrier in answering OSDI items more easily.

Prevalence and Risk Factors Associated with Symptomatic Dry Eye in Nurses in Palestine During the COVID-19 Pandemic

Introduction

Working in closed wards at hospitals during night-time shifts and using electronic health records may raise the risk of dry eye disease in nurses.

Objective

The purpose of the current study was to assess the prevalence and associated factors of dry eye disease among hospital nurses in the North West Bank, Palestine.

Methods

A descriptive cross-sectional study. The study included 300 nurses who work at hospitals in the North West Bank, Palestine. The Ocular Surface Disease Index (OSDI) questionnaire on dry eye disease was used to estimate the prevalence of symptomatic dry eye disease.

Results

The percentage of dry eye disease prevalence among study participants was 62% with an OSDI score of >13 (mild to moderate and severe OSDI status). Nurses who wore contact lenses worked during the night-time, and worked in the intensive care unit were more likely to report significantly higher OSDI scores (p < .05). Moreover, gender, smoking, and computer use were not statistically associated with dry eye disease (p > .05).

Conclusion

Symptomatic dry eye disease is one of the most common ocular diseases among hospital nurses in Palestine.

Computer Vision Syndrome Prevalence and Ocular Sequelae among Medical Students: A University-Wide Study on a Marginalized Visual Security Issue

Introduction:

This study aimed to discover and document the potential of visual and ocular sequelae of computer vision syndrome (CVS) among medical students.

Methods:

This cross-sectional case-control study was conducted on medical students (n=4030) of five universities in Egypt. All students completed a specially designed and validated CVS questionnaire survey (CVS-F3). Students with ≥5 CVS symptoms constituted a risk group (n=352), while students with 1-4 CVS symptoms constituted a low-symptoms group (n=3067). Students from the control and risk groups were examined using objective methods, such as visual acuity, subjective refraction, dry eye disease tests, and anterior segment and fundus examinations. Students who complained of visual blur underwent multifocal electroretinography mfERG examinations (mfERG group).

Results:

The CVS-F3 indicated that 84.8% of students had complaints that might be related to CVS, however, our ophthalmic examination group revealed only a 56% CVS prevalence rate. The most common single screen type used by 70.4% of students was the smartphone, and the most common complaint was headache (50.2%). Multivariate logistic regression analysis revealed that CVS was significantly associated with increased screen-hours, including >2 screen-hours daily (odds ratio [OR], 2.48; P<0.0001), >2 screen-hours at night (OR, 1.79; P=0.003), and ≥3 screen-years (OR, 1.69; P=0.006). In the mfERG group, 37% demonstrated reduced amplitudes of mfERG rings and quadrants, indicating reduced foveal responses.

Conclusion:

CVS-questionnaires overestimate the true CVS prevalence and sequelae, which could be accurately detected by objective ophthalmic examination. Smartphones primarily caused CVS among students, with CVS severity increasing in correlation with shorter eye-to-screen distance and frequent use. Contact lens wearing doubled the risk of CVS development and augmented its severity. CVS might affect macular integrity with screen-induced foveal dysfunction.

Clinical Trials Registration:

PACTR201811618954630.