The data is related to the increase in exposure to digital screens and other risk factors such as diabetes, glaucoma, or blepharitis; the lack of tears and adequate eye hydration can be due to both their lack of production and excessive evaporation, as the use of electronic devices involves staring at the screen for long periods, leading to reduced blinking and less lubrication of the ocular surface.
«We are facing the first study that analyzes the frequency of dry eye disease in Spain, at a population level and applying diagnostic criteria that allow comparing the results obtained. These data are of great interest to health professionals, such as ophthalmologists, epidemiologists, and primary care physicians, among others; but also to the general population, which is often not aware of the pathology or that it can be addressed with an appropriate therapeutic approach,» said Professor José Manuel Benítez del Castillo, Professor of Ophthalmology at the Complutense University and the Clínico San Carlos Hospital and Rementería Clinic (Madrid), leader of this study.
The specialist pointed out that this disease, despite its «undeniable clinical importance,» does not receive adequate attention, emphasizing that a person suffering from severe dry eye has the «same poor quality of life» as a patient with severe angina.
«Generally, these patients are misunderstood by doctors themselves, while this disease is not considered important by health authorities,» Del Castillo, current president of the Spanish Society of Ophthalmology (SEO) and the Spanish Society of Ocular Surface (SESOC), pointed out.
PREVALENCE OF BETWEEN 16.6% AND 22.5%
The research, supported by Laboratorios Théa and involving 3,019 people, has shown that the prevalence of dry eye in Spain ranges from 16.6 percent (applying the criteria of the Woman’s Health Study, WHS) to 22.5 percent (according to the parameters of the Beijing Eye Study, BES); in the latter case, if symptoms such as visual fatigue, which requires closing the eyes, or fluctuating vision while reading, driving, or using a computer are added, the overall prevalence rate would increase to 33 percent.
The data also confirmed that the frequency of the disease is higher in women than in men, with a prevalence of 21.3 percent compared to 10.9 percent, respectively (according to WHS), or 24.6 percent compared to 20.2 percent, respectively (according to BES).
This higher prevalence in women may be due, as explained by Del Castillo, to «hormonal reasons, with specific studies reporting a prevalence of up to 68 percent in postmenopausal women»; however, he ruled out the relationship between dry eye and hormone replacement therapy, recalling that a direct association has been demonstrated with the use of cosmetics, whose compounds can cause dry eye and blepharitis.
By applying both criteria, an increase in prevalence has also been observed from the age of 40, although among young people aged 18 to 30, the prevalence is 30 percent, with only 5.7 percent having received a diagnosis.
Although the data only consider adults, the expert emphasized that more and more cases of children aged 12 to 15 are seen in consultations starting to show symptoms of dry eye due to excessive screen use.
The survey also shows that 12.3 percent claim to have been diagnosed by a doctor, contrasting with the higher prevalence found in this study.
«This data highlights a clear need to increase attention to this disease, with greater and more effective prevention, diagnosis, and treatment, especially in young people, who have a high use of screens and mobile devices, leading to reduced blinking and proper tear lubrication of the ocular surface,» Del Castillo said.
MORE DIAGNOSES IN CASES OF FEWER SCREEN HOURS
A data point from the survey that may seem contradictory is that more diagnoses of dry eye have been found in people with less screen use, while those with more than six hours of daily use have a lower diagnosis.
The doctor explained that, although «the results may seem paradoxical,» they have a «logical» explanation, which is that «when the patient has very dry eyes and is very affected, they use the screen less; that is, as they are already aware that looking at the screen will cause dry eyes because they blink less, they tend to use the devices less.»
Regarding risk factors, Del Castillo stated that in cases of diabetes, peripheral neuropathy can affect the cornea, with alterations and reduced innervation, leading to decreased sensitivity and tear production.
In the case of eye surgeries, «all, without exception, ‘dry out’ the ocular surface, a factor to consider preventively, especially in patients who have undergone successive operations for different pathologies (retina, cataract, glaucoma, etc.).»
Regarding glaucoma medication, Del Castillo detailed that «many of the drugs commonly used to treat this disease contain active ingredients that can dry out the eye, especially if they contain preservatives (such as benzalkonium chloride), resulting in a higher rate of dry eye in patients treated for years for their glaucoma compared to others of the same age without glaucoma.»
This is compounded by a poorer evolution and treatment of glaucoma in the presence of dry eye, as «the patient shows less adherence and therapeutic compliance as the instillation of drops is very uncomfortable due to their dry eyes.»
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