Abstract：
OBJECTIVE: The current subclassifications of dry eye disease (DED) are aqueous deficient (ADDE) and evaporative (EDE) forms, but there lacks consistency in the clinical characteristics used to define each of these. This study used clinical data to inform cut-off values for the subclassification of ADDE and EDE, to allow more consistent study of the epidemiology of both DED subtypes.
METHODS: The study enrolled 261 residents from the UK, extracted from a cohort with demographics representing the population (mean 42.4 ± 18.7 years, 56 % females). The TFOS DEWS II diagnostic criteria were used to identify those with DED. Meibomian gland loss/drop-out (from meibography), lipid layer thickness (LLT - from interferometry graded on the Guillon-Keeler scale), and tear meniscus height (TMH - Keratograph 5M) along with tear evaporation (Delfin Vapometer) were used to characterise the subclassification. The Dry Eye Risk Factor Survey was used to assess risk factors associated with each DED subtype.
RESULTS: Compared to individuals who were not diagnosed with DED, EDE was characterized by signs of meibomian gland loss of > 28 %, LLT grade < 3 and tear evaporation > 46 g/m2/h. In contrast, ADDE was best characterized by a reduced TMH < 0.2 mm. Based on these criteria, the prevalence of ADDE was 6.2 %, EDE was 64.2 %, and 11.1 % exhibited features of both ADDE and EDE, with 18.5 % unclassified despite having a DED diagnosis. Contact lens wear and computer use were risk factors for ADDE (p < 0.05), whereas age was a positive risk factor for EDE (p < 0.01). Meibomian gland loss (occurring in 27.9 %) was the most commonly observed sign in EDE.
CONCLUSIONS: Data driven-classification of DED confirms that the evaporative form is most prevalent and identified that in a generalisable UK population, ADDE alone occurs only in approximately 1 in 16 cases of DED.
METHODS: The study enrolled 261 residents from the UK, extracted from a cohort with demographics representing the population (mean 42.4 ± 18.7 years, 56 % females). The TFOS DEWS II diagnostic criteria were used to identify those with DED. Meibomian gland loss/drop-out (from meibography), lipid layer thickness (LLT - from interferometry graded on the Guillon-Keeler scale), and tear meniscus height (TMH - Keratograph 5M) along with tear evaporation (Delfin Vapometer) were used to characterise the subclassification. The Dry Eye Risk Factor Survey was used to assess risk factors associated with each DED subtype.
RESULTS: Compared to individuals who were not diagnosed with DED, EDE was characterized by signs of meibomian gland loss of > 28 %, LLT grade < 3 and tear evaporation > 46 g/m2/h. In contrast, ADDE was best characterized by a reduced TMH < 0.2 mm. Based on these criteria, the prevalence of ADDE was 6.2 %, EDE was 64.2 %, and 11.1 % exhibited features of both ADDE and EDE, with 18.5 % unclassified despite having a DED diagnosis. Contact lens wear and computer use were risk factors for ADDE (p < 0.05), whereas age was a positive risk factor for EDE (p < 0.01). Meibomian gland loss (occurring in 27.9 %) was the most commonly observed sign in EDE.
CONCLUSIONS: Data driven-classification of DED confirms that the evaporative form is most prevalent and identified that in a generalisable UK population, ADDE alone occurs only in approximately 1 in 16 cases of DED.
摘要：
目的：干眼症（DED）的当前子分类是房水缺乏（ADDE）和蒸发（EDE）形式，但是用于定义这些临床特征缺乏一致性。这项研究使用临床数据来告知ADDE和EDE亚分类的截止值，以便对两种DED亚型的流行病学进行更一致的研究。
方法：这项研究招募了来自英国的261名居民，从人口统计学代表人群的队列中提取(平均42.4±18.7年，56%的女性）。TFOSDEWSII诊断标准用于识别DED患者。睑板腺丢失/脱落（从睑板图），脂质层厚度（LLT-来自Guillon-Keeler量表上分级的干涉测量），和泪液半月板高度（TMH-角膜描记器5M）以及泪液蒸发（DelfinVapometer）用于表征子分类。使用干眼危险因素调查来评估与每种DED亚型相关的危险因素。
结果：与未诊断为DED的个体相比，EDE的特征是睑板腺丧失的迹象>28%，LLT等级<3，撕裂蒸发>46g/m2/h。相比之下,ADDE的最佳特征在于减小的TMH<0.2mm。基于这些标准,ADDE的患病率为6.2%,EDE为64.2%，11.1%表现出ADDE和EDE的特征，尽管有DED诊断，但仍有18.5%未分类。佩戴隐形眼镜和使用电脑是ADDE的危险因素(p<0.05)。而年龄是EDE的积极危险因素(p<0.01)。睑板腺损失（发生在27.9％）是EDE中最常见的体征。
结论：DED的数据驱动分类证实了蒸发形式是最普遍的，并确定了在一般的英国人口中，在16例DED中仅有约1例发生ADDE。
方法：这项研究招募了来自英国的261名居民，从人口统计学代表人群的队列中提取(平均42.4±18.7年，56%的女性）。TFOSDEWSII诊断标准用于识别DED患者。睑板腺丢失/脱落（从睑板图），脂质层厚度（LLT-来自Guillon-Keeler量表上分级的干涉测量），和泪液半月板高度（TMH-角膜描记器5M）以及泪液蒸发（DelfinVapometer）用于表征子分类。使用干眼危险因素调查来评估与每种DED亚型相关的危险因素。
结果：与未诊断为DED的个体相比，EDE的特征是睑板腺丧失的迹象>28%，LLT等级<3，撕裂蒸发>46g/m2/h。相比之下,ADDE的最佳特征在于减小的TMH<0.2mm。基于这些标准,ADDE的患病率为6.2%,EDE为64.2%，11.1%表现出ADDE和EDE的特征，尽管有DED诊断，但仍有18.5%未分类。佩戴隐形眼镜和使用电脑是ADDE的危险因素(p<0.05)。而年龄是EDE的积极危险因素(p<0.01)。睑板腺损失（发生在27.9％）是EDE中最常见的体征。
结论：DED的数据驱动分类证实了蒸发形式是最普遍的，并确定了在一般的英国人口中，在16例DED中仅有约1例发生ADDE。
