. 2022 Oct 27;140(12):1181–1192. doi: 10.1001/jamaophthalmol.2022.4394

Table 2. Prevalence of Dry Eye and Meibomian Gland Dysfunction Results.

Source	Etiology (DED and/or MGD)	Measurement method: components contributing to diagnostic standards	Diagnostic standards	Prevalence denominator, No.	Prevalence numerator, No.	Prevalence, % (95% CI)	Point or period of data collection	Characteristics used to stratify prevalence or report an association	Overall risk of bias
Dana et al,³² 2019	DED	Relevant ICD codes^a; CPT codes for procedures and prescriptions^b; prescription fills^c	(1) Overall DED	(1) 9 732 272	(1) 513 988	(1) 5.3 (5.3-5.3)^g	Period: 2003-2015 (8 y)	Age, sex, year of prevalence estimate (annual prevalence)^h; NRⁱ; NR^j	M
			(2) Unspecified DED^d	(2) 9 732 272	(2) 207 727	(2) 2.1 (2.1-2.1)^g
			(3) Specified DED^e	(3) 9 732 272	(3) 24 809	(3) 0.3 (0.3-0.3)^g
			(4) Sjögren-type DED^f	(4) 9 732 272	(4) 17 403	(4) 0.2 (0.2-0.2)^g
Paulsen et al,³³ 2014	DED	Symptoms^k	Symptoms (questionnaire)^k	3275	475	14.5 (13.3-15.8)^g	Period: 2005-2008 (3 y)	NR^h; NRⁱ; age, sex, medical comorbidities^l, medication use^j^,^m	L
Davis et al,³⁸ 2015	DED	Relevant ICD codes	ICD-9 codeⁿ	460 611	7207	1.6 (1.5-1.6)^g	Period: 2008-2013 (5 y)	NR^h; medical comorbiditiesⁱ^,^o; NR^j	H
Lee et al, 2018³⁹ and 2017⁴⁰	DED	Relevant ICD codes	(1) ICD-9 code^p	(1) 3 265 894	(1) 854 480	(1) 26.2 (26.1-26.2)^g	Period: 2010-2014 (4 y)	NR^h; age, sex, race and ethnicity, medical comorbidities, medication useⁱ; NR^j	M
			(2) ICD-9 code^q	(2) 3 265 894	(2) 843 194	(2) 25.8 (25.8-25.9)^g
			(3) ICD-9 codes^r	(3) 3 265 894	(3) 9315	(3) 0.3 (0.3-0.3)^g
			(4) ICD-9 codes^s	(4) 3 265 894	(4) 28 407	(4) 0.9 (0.9-0.9)^g
			(5) ICD-9 codes^t	(5) 3 265 894	(5) 959 881	(5) 29.4 (29.3-29.4)
			(6) ICD-9 codes^u	(6) 3 265 894	(6) 186 299	(6) 5.7 (5.7-5.7)^g
Russo and Bass,⁴¹ 2021	DED	Relevant ICD codes; other	ICD-10 codes and other (diagnoses contained in the attending optometrist’s assessment and plan)	424	121	28.5 (24.3-33.1)^g	Period: 2016-2017 (1-2 y)	NR^h; NRⁱ; NR^j	H
Farrand et al,⁴² 2017	DED	Self-reported diagnosis^v; symptoms^v	(1) Self-reported diagnosis with symptoms	(1) 73 211	(1) 5051	(1) 6.9 (6.7-7.1)^g	Point: 2013	Age, sex, race and ethnicity, US region, dry eye disease severity^h; NRⁱ; age, sex, race/ethnicity, US region^j	M
			(2) Self-reported diagnosis with symptoms^w	(2) 73 211	(2) NR	(2) 6.8 (6.6-7.0)
			(3) Symptoms without self-reported diagnosis	(3) 75 000	(3) 1789	(3) 2.4 (2.3-2.5)^g
			(4) Symptoms without self-reported diagnosis^w	(4) 75 000	(4) NR	(4) 2.5 (2.3-2.6)
Stull et al,⁴³ 2017	DED	Other	Other (extracted from patient medical records)	400	187	46.8 (41.8-51.8)^g	Point: 2014/2015	NR^h; NRⁱ; NR^j	H
Chang et al,⁴⁴ 2018	DED	Symptoms^x	(1) DEQ-5 ≥6	(1) 233	(1) 94	(1) 40.3 (34.0-47.0)^g	Point: 2016	Dry eye disease severity^h; age, sex, race and ethnicity, medical comorbidities, medication useⁱ; NR^j	M
			(2) DEQ-5 ≥12	(2) 233	(2) 24	(2) 10.3 (6.7-14.9)^g
			(3) Chief concern dry eye symptoms	(3) 233	(3) 60	(3) 25.8 (20.3-31.9)^g
Manoj,⁴⁵ 2016	DED	Signs	(1) Tear hyperosmolarity	(1) 9947	(1) 4605^g	(1) 46.3 (45.3-47.3)^g	NR	Sex, dry eye disease severity^h; medical comorbiditiesⁱ; NR^j	H
Manoj,⁴⁵ 2016	DED	Signs	(2) Tear osmolarity ≥316 mOsm/L	(2) 9947	(2) 2885^g	(2) 29.0 (28.1-29.9)^g	NR		H
Yeh and Lin,³⁵ 2017^y	DED; MGD	Symptoms^z; signs^a ^a	(1) SPEED ≥9	(1) 101	(1) 19	(1) 18.8 (11.7-27.8)^g	Point: NR	Dry eye disease severity^h; age, sex, race and ethnicity, medication useⁱ; NR^j	H
			(2) SPEED ≥6	(2) 101	(2) 43	(2) 42.6 (32.8-52.8)^g
			(3) Meiboscore = 3	(3) 101	(3) 12	(3) 11.9 (6.2-19.8)^g
Alghamdi et al,³⁶ 2016	MGD	Signs^b ^b^,^c ^c	(1) Eyelid vascularity score ≥2	(1) 233	(1) 39	(1) 16.7 (12.2-22.2)^g	Point: NR	Age, sex, race and ethnicity, medical comorbidities, medication use^h; NRⁱ; NR^j	H
Alghamdi et al,³⁶ 2016	MGD	Signs^b ^b^,^c ^c	(2) Meibum quality score ≥2	(2) 233	(2) 129	(2) 55.4 (48.7-61.9)^g	Point: NR		H
Yalamanchili et al,³⁴ 2018	MGD	Relevant ICD codes	(1) ICD and EMR codes for MGD and MGD spectrum disorders	(1) 19 314	(1) 2002	(1) 10.4 (9.9-10.8)^g	Period: 2014-2017 (3 y)	Age, race and ethnicity^h; NRⁱ; NR^j	H

Abbreviations: CPT, Current Procedural Terminology; DED, dry eye disease; DEQ-5, 5-item dry eye questionnaire; EMR, electronic medical record; H, high; ICD-9, International Classification of Diseases, Ninth Revision; ICD-10, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; L, low; M, moderate; MGD, meibomian gland dysfunction; NR, not reported; SPEED, Standardized Patient Evaluation of Eye Dryness.

^{^a}

Driving indicators: 370.33, keratoconjunctivitis sicca; 370.34, exposure keratoconjunctivitis; 372.53, conjunctival xerosis; 375.15, tear film insufficiency, unspecified; 710.20, sicca syndrome, Sjögren; nondriving indicators: 370.20, superficial keratoconjunctivitis; 370.21, punctate keratitis; 714.0, rheumatoid arthritis; 695.4, discoid lupus erythematosus; 710.0, systemic lupus erythematosus; 373.34, discoid lupus erythematosus of eyelid.

^{^b}

Driving indicators: 68 760, closure of the lacrimal punctum (by thermocauterization, ligation, or laser surgery); 68 761, punctal plugs; 09.91, obliteration of lacrimal punctum.

^{^c}

Driving indicator: restasis prescription fill for cyclosporine ophthalmic emulsion.

^{^d}

Using ICD-9 codes 375.15 and 370.33, at least 1 of each or 2 of the same.

^{^e}

Using ICD-9 codes nondriving indicators 370.21 and 370.20, at least 1 of 370.21 or 370.20 and 1 driving indicator (375.15 or 370.33).

^{^f}

Using ICD-9 code driving indicator 710.2, at least 2 of 710.2 OR 1 of 710.2 and 1 driving indicator (375.15 or 370.33).

^{^g}

Derived by binomial “exact” calculation.

^{^h}

Stratified by characteristic.

^ⁱ

Characteristic included in a univariate analysis.

^{^j}

Characteristic included in a multivariate analysis.

^{^k}

Participants were asked “How often do you have dry eyes, a dry, gritty, or burning feeling?”; “How much does the dryness in your eyes bother you?”; “Is there a season of the year when the dryness in your eyes is the worst?”; and “Are you currently using eye drops at least once a day for dry eyes?” Participants who reported that symptoms were present sometimes or more often and that they were moderately bothersome or greater, or those who reported currently using eye drops at least once a day for dry eyes, were considered to be cases.

^{^l}

Arthritis, osteoporosis, allergies, thyroid disease, migraine headache, history of head injury (no loss of consciousness, loss of consciousness <5 minutes, loss of consciousness ≥5 minutes).

^{^m}

Antihistamines, acetaminophen, benzodiazepine, antidepressants, steroids, multivitamin, hormones (women).

^ⁿ

ICD-9 code 375.15.

^{^o}

Diabetes (ICD-9 codes 250.00-250.93).

^{^p}

ICD-9 code indicative of tear film dysfunction (sicca syndrome [710.2] or keratoconjunctivitis sicca [370.33] or tear film insufficiency [375.15]).

^{^q}

ICD-9 code 375.15.

^{^r}

ICD-9 code 710.2.

^{^s}

ICD-9 code 370.33.

^{^t}

“Any dry eye” (tear film insufficiency [375.15] or visual discomfort [368.13] or pain in or around eye [379.91] or sicca syndrome [710.2] or keratoconjunctivitis sicca [370.33]).

^{^u}

ICD-9 code indicative of ocular pain (visual discomfort [368.13] or pain in or around eye [379.91]).

^{^v}

Participants were asked whether they had ever experienced dry eye. Possible responses were yes or no. Those who answered no to ever experiencing dry eye were classified as non-DED and were not asked any other DED-related questions. All participants who said yes were asked a series of dry eye–related questions. The first was whether their dry eye had ever been diagnosed by a physician. Possible responses were yes or no. Those who answered yes to experiencing dry eye but no to being diagnosed by a physician were classified as symptomatic–undiagnosed. Those who confirmed both experiencing dry eye and physician diagnosis were classified as diagnosed-DED and were given a list of symptoms (pain, light sensitivity, gritty sensation, feeling of a foreign body or sand in the eye, itching, redness, and blurring of vision) and asked to select all that applied.

^{^w}

Adjusted using the Horvitz-Thompson estimator and inverse probability weighting.

^{^x}

Using the DEQ-5.

^{^y}

Individual patient data are available.

^{^z}

Using the SPEED.

^{^aa}

Using the Meiboscore.

^{^bb}

Using the eyelid vascularity score (0-3).

^{^cc}

Using the meibum quality score (0-4).