Subjective dry eye symptoms and associated factors among the national general population in China during the COVID-19 pandemic: A network analysis

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has presented numerous challenges to public health, including the emergence of subjective dry eye symptoms among individuals. However, there is currently a dearth of comprehensive knowledge regarding the associated factors with subjective dry eye symptoms in the general population. METHODS: A nationwide survey in China was carried out from 20 June to 31 August 2022, involving 21 916 participants. Subjective dry eye symptoms were assessed using the Ocular Surface Disease Index-6. We employed random forest classification to select potential associated factors based on the socioecological model. We also conducted univariate and multivariable logistic regression analyses to explore the factors associated with subjective dry eye symptoms. Network analyses were employed to explore the network structure of subjective dry eye symptoms and associated factors. RESULTS: The item “watching TV (or similar task)” displayed the highest node strength and exhibited the highest predictability within the network. The results of the multivariate logistic regression analysis demonstrated significant associations between subjective dry eye symptoms and several factors, including loneliness (odds ratio (OR) = 1.29; 95% confidence interval (CI) = 1.26 to 1.32), problematic Internet use (OR = 1.08; 95% CI = 1.08 to 1.09), family communication (OR = 1.01; 95% CI = 1.00 to 1.01), the presence of depression (OR = 1.53; 95% CI = 1.39 to 1.68) and anxiety (OR = 1.31; 95% CI = 1.17 to 1.47) symptoms, older age (OR = 1.01; 95% CI = 1.01 to 1.01), self-rated health status (OR = 0.99; 95% CI = 0.98 to 0.99), family health (OR = 0.97; 95% CI = 0.96 to 0.97), health literacy (OR = 0.98; 95% CI = 0.97 to 0.99) and the agreeableness personality trait (OR = 0.97; 95% CI = 0.95 to 0.99). CONCLUSIONS: These findings have important implications for public health interventions targeting the prevention and management of subjective dry eye symptoms in the general population. Strategies addressing individual risk factors and supporting psychological well-being may prove beneficial in mitigating the burden associated with subjective dry eye symptoms.