Prevalence and risk factors associated with dry eye symptoms: a population based study in Indonesia. (World View).

Aim: To determine the prevalence and identify associated risk factors for dry eye syndrome in a population in Sumatra, Indonesia.

Methods: A one stage cluster sampling procedure was conducted to randomly select 100 households in each of the five rural villages and one provincial town of the Riau province, Indonesia, from April to June 2001. Interviewers collected demographic, lifestyle, and medical data from 1058 participants aged 21 years or over. Symptoms of dry eye were assessed using a six item validated questionnaire. Presence of one or more of the six dry eye symptoms often or all the time was analysed. Presence of pterygium was documented.

Results: Prevalence of one or more of the six dry eye symptoms often or all the time adjusted for age was 27.5% (95% confidence interval (Cl) 24.8 to 30.2). After adjusting for all significant variables, independent risk factors for dry eye were pterygium (p<0.00l, multivariate odds ratio (OR) 1 .8; 95% Cl 1 .4 to 2.5) and a history of current cigarette smoking (p=0.05, multivariate OR 1.5; 95% Cl 1.0 to 2.2).

Conclusions: This population based study provides prevalence rates of dry eye symptoms in a tropical developing nation. From our findings, pterygium is a possible independent risk factor for dry eye symptoms.

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Dry eye represents a multifactorial, heterogeneous disorder of the preocular tear film, which results in ocular surface disease. The tear film and ocular surface form a complex and stable system that can lose its equilibrium through numerous disturbing factors. (1)

Reduction in quality of life is inevitable when symptoms of dry eye occur. These symptoms range from mild transient irritation to persistent dryness, burning, itchiness, redness, pain, ocular fatigue and visual disturbance. In the United States alone, approximately 7-10 million Americans require artificial tear preparations, with consumers spending over $100 million/year. (2)

Reported prevalence of dry eye is diverse, with questionnaire based surveys documenting rates ranging from 14.4% to 33% of the population sampled. (3-6) Studies which also involve tests of tear function including Schirmer's test, tear break up time, fluorescein staining, or rose bengal staining for determination of dry eye have found generally lower prevalence rates. (6,7) Limitations in comparisons of studies in different populations include different age distribution of the population, definitions of dry eye, or methodology. Most studies of dry eye are confined to developed nations and older populations, with resultant lack of ethnic diversity. (5-8)

We aimed therefore to report the prevalence of dry eye symptoms in Sumatra, Indonesia, and to identify possible associated risk factors.

MATERIALS AND METHODS

Study population

A large population based prevalence survey of general health, respiratory symptoms, and vision was conducted in five rural villages (Kuala Terusan Baru, Pelalawan, Delik, SP7, and Segati) and one provincial town (Pangkalan Kerinci) of the Riau province, Sumatra, Indonesia, in people 21 years or older during the period April to June 2001. The region of study was District Pelalawan, a tropical area with secondary forests near the Kampar river and the nearest large city is the capital of the Riau province, Pekan Baru.

All houses in each village were individually mapped and assigned a number by an enumeration team. A one stage cluster sampling procedure was conducted whereby 100 households (as there were only a total of 60 households in Delik, all 60 were assessed) were randomly selected from a sampling frame of the total number of households in each village. Of these, 216 subjects recruited from Kerinci, 231 subjects from Kuala Terusan Baru, 229 from Pelalawan, 120 from Delik, 233 from SP7, and 181 from Segati were above 21 years of age (total = 1210). Non-contactables were defined as individuals who were not contactable on three occasions and refusals defined as individuals who declined to participate in the study.

Training of team members and a pilot study of 16 subjects in SP7 were conducted in April 2001, 2 weeks before the survey proper. Before the examinations, meetings were held with the village leaders to explain the purpose of the study and to obtain cooperation from the community. Informed verbal consent was obtained from the subjects and all subjects were treated in accordance with the tenets of the Declaration of Helsinki. …