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Glaucoma Dry Eye Disease
Prevalence of Dry Eye Disease in Glaucoma
Carl Erb
Medical Director, Ophthalmology Department, Schlosspark Clinic, Berlin
Abstract
Data from over 20,000 German patients with glaucoma have provided valuable information regarding the prevalence of dry eye disease (DED)
in these patients. Overall, more women develop DED with glaucoma than men (56.9 versus 45.7%), and the prevalence increases with age, with
more than half of patients 60 years of age having symptoms. Hypertension co-exists with glaucoma in 48.1% of patients, and the highest level
of DED is found in patients with dry mouth, nose and skin (75.5%). DED occurs more often when three or more antiglaucoma eyedrops are used,
and with longer disease duration. This suggests that it is related to the presence of the preservative benzalkonium chloride, and that using
preservative-free eyedrops to break the vicious circle of DED is likely to enhance patient compliance and improve the care of glaucoma patients.
Keywords
Dry eye, glaucoma, preservative-free, compliance
Disclosure: The author has no conflicts of interest to declare.
Received: 9 August 2009 Accepted: 18 August 2009
Correspondence: Carl Erb, Schlosspark-Klinik, Department of Ophthalmology, Heubnerweg 2, 14059 Berlin, Germany. E:
carl.erb@schlosspark-klinik.de
Glaucoma is a chronic progredient neuropathy with typical structural nose and skin (11.3%) and obesity (11.2%). Overall, the presence of any
changes at the optic nerve head and functional defects in the visual concomitant disease increases the percentage of dry eye reported by
fields leading to blindness at the end stage. It is estimated that 60.5 glaucoma patients. Of those glaucoma patients with dry mouth, nose
million people worldwide will have this disease by 2010 and this and skin, 75.5% also suffer from dry eye, and it is found in 68.2% of those
number will increase to about 80 million by 2020. Glaucoma is the with depressive episodes, 66.1% of those with arthritis and 65.6% of
second leading cause of blindness in the world.
1
Furthermore, dry eye those with skin diseases.
disease (DED) is a leading cause of patient visits to ophthalmologists.
2
Both glaucoma and DED are multifactorial disorders.
3,4
In a review of the Gender and Age Differences
prevalence of DED it was shown that the variation of prevalence of DED The gender distribution of the registry population is 60.9% female
across studies is very high, differing from <0.1 to 33%,
5
depending on (n=12,493) and 39.1% male (n=8,013).
10
The German registry data found
how DED was defined. However, in large studies the age-adjusted that women with glaucoma were significantly more likely to develop dry
prevalences at >50 years of age in the US and Spain were from 3.9 to eye than men with glaucoma (56.9% versus 45.7%; p<0.0001). This is in
11.9%,
6–8
and at ≥65 years between 15 to 34%.
9
At this age, the agreement with other studies that found a predominance of DED
prevalence of DED increased with age and with female gender. in women,
5,6,8,11
but it seems to be an ethnic phenomenon because in
Turkish normal volunteers
12
no significant differences in tear function
Since glaucoma and DED are very common in the elderly, we were between the genders have been observed, and in an Asian population
interested in the prevalence of DED in different glaucoma types and in the prevalence of DED was significantly higher in men compared with
a very large sample size. The German Glaucoma and Dry Eye Register women.
13
The data from the German study indicate a steady rise in the
includes analysable data from a total of 20,506 individuals with prevalence of dry eye with increasing age, ranging from 31.3% at <40
diagnosed glaucoma taken from 900 ophthalmological centres across years of age to 61.6% at 90 years of age or older. Splitting out the age-
Germany. This information has allowed the relationship between the frequency data by gender shows that this factor appears to influence
occurrence of dry eye and potential causative factors to be dissected the occurrence of dry eye from about 50 years of age. Roughly 10%
in detail.
10
Overall, 52.6% of glaucoma patients have a concomitant more female than male glaucoma patients 50–60 years of age report the
diagnosis of dry eye versus 47.4% who do not. development of dry eye, and this differential is maintained with age.
Incidence of Concomitant Diseases Effect of Antiglaucoma Drug Treatment and
Patients were asked directly about any concomitant illnesses and Duration of Disease on the Incidence of Dry
vascular risk factors they were aware of being affected by, and 16 such Eye and Other Local Symptoms
health concerns are found to co-exist with glaucoma. Irrespective of The German Glaucoma and Dry Eye Register reports a positive
glaucoma type, hypertension is the most frequent of these, being correlation between the number of different antiglaucoma eyedrops
reported by 48.1% of patients, followed by diabetes (22.5%), dry mouth, used and the frequency of dry eye: 50.9% of patients (n=13,474) using
© TOUCH BRIEFINGS 2009 49
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