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Published on: May 25, 2022
Prevalence of dry eye disease among children: a systematic review and meta-analysis
Yuhao Zou1, Dongfeng Li1,2, Virgili Gianni3,4
1Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Insights
Dry eye disease (DED) affects nearly a quarter of children globally. Factors like latitude, temperature, and the COVID-19 pandemic significantly impact its prevalence, highlighting the need for standardized diagnosis.
Area of Science:
- Ophthalmology
- Pediatrics
- Epidemiology
Background:
- Dry eye disease (DED) is a prevalent ocular surface condition causing discomfort and visual impairment.
- Increasing digital device use and lifestyle changes raise concerns about rising DED rates in children.
- Understanding pediatric DED prevalence is vital for targeted diagnostic and management strategies.
Purpose of the Study:
- To systematically review and meta-analyze the global prevalence of dry eye disease in children.
- To investigate factors influencing pediatric DED prevalence, including diagnostic criteria and geographical variations.
- To assess the impact of the COVID-19 pandemic on the prevalence of DED in pediatric populations.
Main Methods:
- A comprehensive literature search was conducted across multiple databases from January 2001 to April 2024.
- Prevalence estimates from 41 eligible studies (48,479 participants) were pooled using random-effects models.
- Subgroup and meta-regression analyses explored heterogeneity and identified influencing factors.
Main Results:
- The overall estimated prevalence of DED in children was 23.7%.
- Prevalence varied significantly based on diagnostic criteria: 16.6% for clinical signs versus 34.6% for reported symptoms.
- Post-COVID-19 pandemic DED prevalence (44.1%) was substantially higher than pre-pandemic rates (18.7%).
- Lower latitude and higher mean annual temperatures were associated with increased DED prevalence in children.
Conclusions:
- Dry eye disease is a significant health concern for children under 18, representing a substantial disease burden.
- Standardizing diagnostic criteria for pediatric DED is essential for accurate assessment and research.
- Further research into additional risk factors is necessary to fully elucidate the epidemiology of DED in children.
Background:
Dry eye disease (DED) is a multifactorial disorder of the tear film and ocular surface instability that causes ocular discomfort and visual impairment. The increasing use of digital devices and changing lifestyle patterns have raised concerns about a potential rise in DED among children. Understanding the prevalence of paediatric DED is crucial for developing effective diagnostic and management strategies tailored to this vulnerable population.
Method:
An exhaustive literature search was performed on several databases covering the period from 1 January 2001 to 1 April 2024. Prevalence estimates of DED were combined using random effects models, and heterogeneity sources were explored through subgroup and regression analyses.
Results:
Our literature search identified 7309 articles, of which 41 articles, representing 42 study cohorts (48 479 participants) included in the systematic review. The estimated prevalence of DED among children was 23.7% (95% CI 18.5% to 28.9%). The prevalence of DED by different diagnostic criteria (clinical signs vs reported symptoms by questionnaire) was 16.6% (95% CI 13.7% to 19.5%; 26 studies; 27 107 children) vs 34.6% (95% CI 23.7% to 45.6%; 16 studies; 21 372 children; p<0.01), respectively. The prevalence of DED after the COVID-19 pandemic outbreak was 44.1% (95% CI 25.5% to 62.7%; 8 studies; 9163 children), which was significantly higher than the 18.7% (95% CI 15.6% to 21.9%; 34studies, 39 316 children; p=0.01) before the COVID-19 outbreak. High between-study heterogeneity was noted (I2>92%). In meta-regression analysis, the prevalence of DED among children increased by 7.1% with each 10° decrease in latitude (p=0.015), and by 10.2% with each 10° increase in mean annual temperature (p=0.024).
Conclusions:
DED is common in children up to 18 years of age and poses a significant disease burden. Standardisation of the diagnosis of DED in children and further study of other risk factors are needed to fully explain the epidemiology of DED in children.
