Meibomian Gland Dysfunction and Sex as Risk Factors of Dry Eye Disease in a Cohort of Norwegian 65-year-Olds: A Cross-Sectional Study

Reza A Badian,1– 3 Vibeke Sundling,1 Janicke Liaaen Jensen,4 Håvard Hynne,4 Behzod Tashbayev,4 Lene Hystad Hove,5 Tor Paaske Utheim,1,2,6– 11 Xiangjun Chen1,2,4,8,9,12 1National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Notodden, Norway; 2Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; 3The Norwegian Dry Eye Clinic, Oslo, Norway; 4Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway; 5Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway; 6Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway; 7Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; 8Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; 9Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway; 10Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway; 11Department of Ophthalmology, Østfold Hospital Trust, Moss/Kalnes, Norway; 12Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, NorwayCorrespondence: Reza A Badian, Email [email protected]: Dry eye disease (DED) is a multifactorial condition characterized by the loss of ocular surface homeostasis, causing discomfort and ocular symptoms. Higher age, female sex, and meibomian gland dysfunction (MGD) are some of the reported risk factors for DED. However, age-specific studies of DED are rare. This study aimed to determine the prevalence of DED and MGD in a cohort of Norwegians in their mid-60s. Additionally, to investigate potential sex-related differences in the prevalence of DED and MGD.Methods: For this cross-sectional study, a random sample of 137 demographically homogeneous Norwegian residents of Oslo in their mid-60s was recruited. Participants completed the Ocular Surface Disease Index (OSDI) dry eye symptom questionnaire and underwent clinical dry eye examinations. DED was defined as OSDI ≥ 13, accompanied by fluorescein break-up time (FBUT) < 10s and/or ocular surface staining (OSS) ≥ 1. The presence of MGD was defined as a score of 1 for both meibum quality (MQ) and meibum expressibility (ME) or a score > 1 for either MQ or ME.Results: The overall prevalence for DED was 20.4% [95% CI: 14.0 to 28.2], and for MGD was 90.5% [95% CI: 84.3– 94.9]. No significant sex differences were observed for either condition. MGD was highly prevalent among both DED and non-DED participants: all individuals with DED (n = 28) had MGD, while among those without DED (n = 109), prevalence was 88.1% (males: 85.7%; females: 90.0%). No significant correlation was found between MGD and sex (rs ([137] = [0.075], p = 0.413). In the whole cohort, OPI and FBUT correlated positively with ME (rs ([132] = [0.437] and rs ([132] = [0.296], both p < 0.001) and negatively with OSS (rs ([132] = [− 0.315] and rs ([132] = [0.423], both p< 0.001) and lid margin abnormality (rs ([130] = [− 0.222], p = 0.011; rs ([132] = [0.234], p = 0.007). FBUT correlated also positively with tear production (rs ([128] = [0.308], p< 0.001). A more frequent use of topical ocular lubricant was found among females (p = 0.043). In the symptomatic group, females had significantly lower OPI and FBUT values (p = 0.046 and 0.027, respectively). Among symptomatic participants, categorized as mild (OSDI 13– 22), moderate (OSDI 23– 32), and severe (OSDI 33– 100), only in the severe group did females show higher OSDI scores (p= 0.042) but lower OSS (p= 0.031) compared to males.Conclusion: In this cohort of Norwegians in their mid-60s, DED and MGD were highly and equally prevalent among both sexes. The high prevalence of these conditions underscores the need to raise awareness of DED and MGD within the young elderly population.Keywords: dry eye disease, meibomian gland dysfunction, sex differences, young elderly, prevalence, age-specific