Prevalence and Severity of Dry Eye Disease Symptoms Among Diabetics: A Nationwide Survey

Introduction: Diabetes mellitus (DM) microvascular complications can impair corneal sensitivity and lacrimal gland functioning, leading to dry eye disease (DED). Hence, this study aimed to measure the prevalence and severity of DED symptoms, and the related risk factors, among the Saudi diabetic population. Methods: This is a retrospective, cross-sectional, survey-based study which targeted Saudi adults (20 years and older) previously diagnosed with type 1 or type 2 DM. It was conducted in eight primary healthcare centers (PCHs) scattered around eight different provinces of Saudi Arabia (SA). The prevalence and severity of DED were measured by the Ocular Surface Disease Index (OSDI). Results: The total study population was 389 subjects, of which 182 (46.8%) were males and 207 (53.2%) were females. The overall prevalence of DED was 51.7%. Among those, 20.3% of patients had mild dryness, 11.1% had moderate dryness, and 20.3% had severe dryness. Glycosylated hemoglobin (HbA1c) levels of 6.5% or higher proved to be an independent risk factor for the development of DED symptoms, 3.6-folds higher for HbA1c levels of 6.5% to 9% (AOR=3.573; p=0.001), and 2.3-folds higher for HbA1c levels higher than 9% (AOR=2.293; p=0.013). The long duration of diabetes did not show a significant association with manifesting DED symptoms (p=0.263). Conclusion: Half of the diabetic population complained of DED symptoms, compared to one-third of the previously studied general Saudi population. Patients with mild to moderate HbA1c elevation were more likely to report DED symptoms than those with severe elevation, which could be related to impaired corneal sensation. Therefore, a routine ophthalmological examination is recommended.