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Ocul Surf. 2017 Jul;15(3):334-365. doi: 10.1016/j.jtos.2017.05.003. Epub 2017 Jul 20.

TFOS DEWS II Epidemiology Report.

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School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia. Electronic address:
University of Campinas, Discipline of Ophthalmology, Faculty of Medical Sciences, Brazil.
Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA.
School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia.
Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Pellegrin Hospital, Bordeaux, 33000, France.
Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Epidemiology, Harvard TH Chan School of Public Health, USA; John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, USA.
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital, London, United Kingdom; Department of Ophthalmology, King's College London, St Thomas' Hospital, London, United Kingdom; Departments of Ophthalmology and Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Ophthalmology, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain.
Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
Centre for Contact Lens Research, School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.


The subcommittee reviewed the prevalence, incidence, risk factors, natural history, morbidity and questionnaires reported in epidemiological studies of dry eye disease (DED). A meta-analysis of published prevalence data estimated the impact of age and sex. Global mapping of prevalence was undertaken. The prevalence of DED ranged from 5 to 50%. The prevalence of signs was higher and more variable than symptoms. There were limited prevalence studies in youth and in populations south of the equator. The meta-analysis confirmed that prevalence increases with age, however signs showed a greater increase per decade than symptoms. Women have a higher prevalence of DED than men, although differences become significant only with age. Risk factors were categorized as modifiable/non-modifiable, and as consistent, probable or inconclusive. Asian ethnicity was a mostly consistent risk factor. The economic burden and impact of DED on vision, quality of life, work productivity, psychological and physical impact of pain, are considerable, particularly costs due to reduced work productivity. Questionnaires used to evaluate DED vary in their utility. Future research should establish the prevalence of disease of varying severity, the incidence in different populations and potential risk factors such as youth and digital device usage. Geospatial mapping might elucidate the impact of climate, environment and socioeconomic factors. Given the limited study of the natural history of treated and untreated DED, this remains an important area for future research.


Dry eye disease; Incidence; Natural history; Prevalence; Quality of life; Questionnaire; Risk factor; Societal cost

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