International Ophthalmology

, Volume 39, Issue 12, pp 2731–2739 | Cite as

Population-based study on the epidemiology of dry eye disease and its association with presbyopia and other risk factors

  • Elsa L. C. Mai
  • Chih-cheng Lin
  • Iebin Lian
  • Renhao Liao
  • Meiling Chen
  • Chaokai ChangEmail author
Original Paper



To investigate the incidence and prevalence of dry eye disease (DED) in Taiwan and to explore its potential risk factors.


Population-based longitudinal data from 2000 to  2013 based on Taiwan National Health Insurance Research Database were used in this study. To explore potential risks factor of interest, patients who had DED diagnosis before the exposure were excluded. Each patient from the exposure and his/her matched non-exposure controls were followed until either the diagnosis of DED or censorship. Kaplan–Meier method was used to compare the hazard of DED between cohorts. Stratified Cox proportional hazard models were applied to estimate the adjusted effect.


The age-adjusted prevalence for men and women were 6.81% and 16.16%, respectively. The age–gender rate of the same period was 549 per 105 person-years. The propensity-adjusted hazard ratio of DED is 1.816 for the presbyopia versus non-presbyopia (with 95% CI = [1.737, 1.897] with p value < 0.0001).


The DED incidence for women peaked at age 50–74, while that for men peaked at age ≧ 75. The incidence in young people seems stable both for women and for men. While exploring the factors of DED, there is a significant association between presbyopia and DED even after matching age/gender and comorbidity conditions. Further clinical studies are needed to justify whether the corrective refractive treatment such as presbyopic glasses to treat the frequently hyperopic status of these patients could be beneficial to both dry eye and presbyopic condition.


Presbyopia Dry eye disease Cox regression Propensity score 



Dry eye disease


Diabetes mellitus


Laser-assisted in situ keratomileusis


Meibomian gland dysfunction


National Health Insurance Research Database


Ocular Surface Disease Index


Penetrating keratoplasty


Propensity score


Systemic lupus erythematosus


Video display terminal



The authors would like to thank Taiwan National Health Research Institute for the approval of using the National Health Insurance Research Data.

Authors’ contribution

EM conceived the study and drafted the manuscript, CL participated in the design of the study and coordination, IL coordinated the statistical analysis and interpreted the results, RL and CM carried out the data management and analysis, and CC carried out the epidemiological studies and revised the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Availability of data and materials

Data used in analysis are available upon request to corresponding author.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All personal identification numbers in NHIRD used in this study were encrypted by conversion into scrambled numbers before data processing. Because the database used consists of de-identified secondary data released for research purposes, this study was exempt from full review by the Institutional Review Board National Changhua University of Education (No. NCUEREC-103-211).

Supplementary material

10792_2019_1117_MOESM1_ESM.xlsx (30 kb)
Supplementary material 1 (XLSX 30 kb)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Elsa L. C. Mai
    • 1
  • Chih-cheng Lin
    • 2
  • Iebin Lian
    • 3
  • Renhao Liao
    • 3
  • Meiling Chen
    • 2
  • Chaokai Chang
    • 4
    Email author
  1. 1.Far Eastern Memorial HospitalTaipeiTaiwan, ROC
  2. 2.Yuanpei University of Medical TechnologyHsinchuTaiwan, ROC
  3. 3.National Changhua University of EducationChanghuaTaiwan, ROC
  4. 4.Taipei Nobel Eye ClinicTaipeiTaiwan, ROC

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