| Objective:To study the epidemiological distribution of dry eye and its risk factors of clinical ophthalmic outpatients in China.And to evaluate the clincical value of McMonnies questionnaire in China.Methods:A cross-sectional,observational study using clinical epidemiological investigation method was conducted from July to November in 2013. We randomly selected 94 hospitals (research centers) in 45 cities from 23 provinces.We recruited 31124 cases in ophthalmic clinic by registration orders finally. The patients meeting the criteria filled the McMonnies questionnaireand did clinical examinations by trained medical practitioners. We used the chi-square test and Logistic regression to analyze the risk factors of dry eye. With clinical diagnosis as the gold standard, we used sensitivity, specificity, Kappa value, Youden’s index, the area under the receiver-operating characteristic curve index to evaluate the effect of the questionnaire in the diagnosis of dry eye.Results:The study recruited 31124 patients,15295 (49.1%) patients of male and 15829(50.9%) patients of female.The mean of tear breakup time was 7.45s,that of Schirmer I test was 7.61mm/5min,the positive rate of angle of conjunctival fluorescein staining test was 41.9%.The three objective examination results of female were poorer than that of male,and higher age group are poorer than those of the lower age group.The prevalence of dry eye in a ophthalmic outpatient population was 67.9%, and the prevalence of female(72.7%) was higher than that of male (62.8%), the difference was statistically significant.But in the young age group(less than 25 years old), the prevalence of male was higher than that of female.The prevalence of dry eye in the young age groupwas 54.3%; and that of the middle age group(between 25 and 45 years old) was 65.9%;and that of the old age group (more than 45 years old)was 79.1%.The prevalences of dry eye disease in different age groups also had statistical differences,but there was no statistically significant differences between the young age group and the middle age group. Logistic multi-factors analysis results showed that compared with male, the OR and its 95% confidence interval of female was 1.61 (1.50,1.73); With the young age group as the control group,that of the old age group was 2.04(1.84,2.28),and that of the middle age group was 1.15 (1.05,1.26). Associated with corneal refractive surgery, diabetes, arthritis and thyroid disease, the OR and its 95% confidence interval were 1.31 (1.19,1.44),1.56 (1.35,1.79) and 1.79 (1.55,2.08) and 2.66 (2.22, 3.17) respectively.The mean score of the McMonnies questionnaire was 15.0,the mean score of femal(16.3) was higher than that of male(13.7).The prevalence of dry eye diagnosed by the McMonnies questionnaire was 55.7%, and the prevalence of female(63.2%) was higher than that of male (47.9%), the difference was statistically significant.But in the young age group(less than 25 years old), the prevalence of male was higher than that of female.The prevalence of dry eye in the young age groupwas36.1%;and that of the middle age group(between 25 and 45 years old) was52.8%;and that of the old age group (more than 45 years old)was72.5%.The prevalences of dry eye disease in different age groups also had statistical differences,but there was no statistically significant differences between the young age group and the middle age group. The sensitivity of McMonnies questionnaire was 76.6% and the specificity was 86.0%. Kappa value was 0.573, Youden’s index was 0.626.The area under the ROC curve of McMonnies questionnaire diagnosis was 0.865,95% confidence interval was from 0.861 to 0.861. The area under the ROC curve of male (0.857) was lower than that of female (0.867). The areas under the ROC curve of the young age group to old age group were 0.860,0.854,0.851respectively. The areas under the ROC curve of McMonnies questionnaire diagnosis in different symptoms were between 0.862 and 0.888.Conclusion:The prevalence of dry eye disease of female was higher than that of male.The prevalence of dry eye disease of the higher age group was higher than that of the lower age group. Gender, age, history of corneal refractive surgery, diabetes, arthritis, and thyroid diseases were risk factors for dry eye. McMonnies questionnaire had good diagnostic value in clinic in China. |
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