Adult male-specific inverse association between dry eye disease and intraocular pressure: KNHANES 2010-2012

PURPOSE

To investigate the association between dry eye disease (DED) and intraocular pressure (IOP) in the general adult population of South Korea.

METHODS

We enrolled 13,194 adults (age ≥19 years) who had participated in the fifth Korea National Health and Nutrition Examination Survey conducted from 2010 to 2012. IOP was measured using Goldman applanation tonometry. DED was defined as the presence of self-reported symptoms along with a diagnosis by an ophthalmologist. As the correlation between the left and right eyes was high (r = 0.833), only the measurement values of the right eye were used. We sequentially conducted multiple linear and logistic regression analyses to investigate the association between DED and IOP and prevalence of high IOP (>21 mmHg).

RESULTS

The prevalence of DED in Korean adults was 7.8%, and the geometric mean of IOP in the right eye was 13.7 ± 1.0 mmHg. In the fully adjusted model, participants with DED had a significantly lower IOP compared to those without DED in the overall population (β = -0.032; 95% confidence interval [CI]: -0.059, -0.004). This trend was evident in males (β = -0.059; 95% CI: -0.106, -0.012) but not in females. Similarly, males with DED had a significantly lower prevalence of high IOP compared to those without DED (odds ratio [OR] = 0.18; 95% CI: 0.04, 0.91), but this association was not evident in females.

CONCLUSIONS

This study suggests that DED is associated with lower IOP in adult Korean males.

TFOS DEWS II Sex, Gender, and Hormones Report

One of the most compelling features of dry eye disease (DED) is that it occurs more frequently in women than men. In fact, the female sex is a significant risk factor for the development of DED. This sex-related difference in DED prevalence is attributed in large part to the effects of sex steroids (e.g. androgens, estrogens), hypothalamic-pituitary hormones, glucocorticoids, insulin, insulin-like growth factor 1 and thyroid hormones, as well as to the sex chromosome complement, sex-specific autosomal factors and epigenetics (e.g. microRNAs). In addition to sex, gender also appears to be a risk factor for DED. "Gender" and "sex" are words that are often used interchangeably, but they have distinct meanings. "Gender" refers to a person's self-representation as a man or woman, whereas "sex" distinguishes males and females based on their biological characteristics. Both gender and sex affect DED risk, presentation of the disease, immune responses, pain, care-seeking behaviors, service utilization, and myriad other facets of eye health. Overall, sex, gender and hormones play a major role in the regulation of ocular surface and adnexal tissues, and in the difference in DED prevalence between women and men. The purpose of this Subcommittee report is to review and critique the nature of this role, as well as to recommend areas for future research to advance our understanding of the interrelationships between sex, gender, hormones and DED.

Sex hormones and the dry eye

The greater prevalence of dry eye in women compared to men suggests that sex hormones may have a role in this condition. This review aims to present evidence for how sex hormones may affect the ocular structures involved in the production, regulation and maintenance of the normal tear film. It is hypothesised that hormone changes alter the homeostasis of the ocular surface and contribute to dry eye. Androgens impact on the structure and function of the meibomian and lacrimal glands and therefore androgen deficiency is, at least in part, associated with the aetiology of dry eye. In contrast, reports of the effects of oestrogen and progesterone on these ocular structures and on the conjunctiva are contradictory and the mechanisms of action of these female-specific sex hormones in the eye are not well understood. The uncertainty of the effects of oestrogen and progesterone on dry eye symptoms is reflected in the controversial relationship between hormone replacement therapy and the signs and symptoms of dry eye. Current understanding of sex hormone influences on the immune system suggests that oestrogen may modulate a cascade of inflammatory events, which underlie dry eye.