The epidemiology of dry eye disease in the UK: The Aston dry eye study

M. Vidal-Rohr, J.P. Craig, L.N. Davies, J.S. Wolffsohn

Research output: Contribution to journalArticlepeer-review


Purpose: Cross-sectional studies on dry eye disease (DED) have relied on different diagnoses hindering conclusions about the disease epidemiology. This study offers an insight into DED epidemiology in the UK using prior and recent diagnostic recommendations. Methods: Study participants comprised 282 volunteers from Birmingham, UK (median 40 years, range 18–88 years, 56% females). DED was defined by the Tear Film Ocular Surface Dry Eye Workshop II (TFOS DEWS II) criteria, based on a positive symptom score with the Dry Eye Questionnaire (DEQ-5) and Ocular Surface Disease Index (OSDI), and one of the following homeostasis markers: non-invasive tear break-up time of < 10 s (Oculus Keratograph 5M); the highest osmolarity value of ≥ 308 mOsm/L among eyes or an interocular osmolarity difference of > 8 mOsm/L (TearLab Osmolarity System); or > 5 corneal spots, >9 conjunctival spots or lower/upper lid-wiper-epitheliopathy staining of ≥ 2 mm length and ≥ 25% width (Oculus Keratograph 5 M). In addition, the Women's Health Study (WHS) criteria, based on symptoms or a prior dry eye diagnosis, was assessed. DED risk factors were gathered using a self-administered questionnaire. Results: DED prevalence by the TFOS DEWS II criteria was 32.1% (95% confidence interval 25.5–37.7% and 29.5% (95% confidence interval 24.4–35.1% by the WHS criteria. Female sex, systemic and/or ocular health conditions, short sleep duration and prolonged outdoor leisure time spent were significant DED risk factors (p ≤ 0.05). Conclusions: Approximately one-third of the adult UK population have DED, aligning with the prevalence reported in multiple counties globally. Female sex, systemic/ocular health conditions, short sleep duration and prolonged outdoor leisure time are positive predictors of DED.

Original languageEnglish
Article number101837
Number of pages7
JournalContact Lens and Anterior Eye
Issue number3
Early online date30 Mar 2023
Publication statusPublished - Jun 2023

Bibliographical note

Funding Information:
This study received funding by EU Horizon 2020 research and innovation programme under Marie Sklodowska-Curie grant agreement No 642760. The authors thanks Dr. Tugce Ipek and Dr. Francesco Menduni for their support with this work.

Copyright © 2023 The Authors. Published by Elsevier Ltd on behalf of British Contact Lens Association. This is an open access article under the CC BY license (


  • Diagnosis
  • Dry eye disease
  • Prevalence
  • Risk factor


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