The Epidemiology of Dry Eye in Melbourne, Australia Cathy A. McCarty, PhD, MPH,’ Aashish K. Bansal, MD,2 Patricia M. Livingston, PhD,’ Yury L. Stanislausky, MD,’ Hugh R. Taylor, MD, FRACO’ Objective: To describe the epidemiology of dry eye in the adult population of Melbourne, Australia. Design: A cross-sectional prevalence study. Partlclpants: Participants were recruited by a household census from two of nine clusters of the Melbourne Visual Impairment Project, a population-based study of age-related eye disease in the 40 and older age group of Melbourne, Australia. Nine hundred and twenty-six (82.3% of eligible) people participated: 433 (46.8%) were male. They ranged in age from 40 to 97 years, with a mean of 59.2 years. Main Outcome Measures: Self-reported symptoms of dry eye were elicited by an interviewer-administered questionnaire. Four objective assessments of dry eye were made: Schirmer’s test, tear film breakup time, rose bengal staining, and fluorescein cornea1 staining. A standardized clinical slit-lamp examination was performed on all participants. Dry eye for the individual signs or symptoms was defined as: rose bengal > 3, Schirmers < 8, tear film breakup time < 8, > ‘& fluorescein staining, and severe symptoms (3 on a scale of 0 to 3). Results: Dry eye was diagnosed as follows: 10.8% by rose bengal, 16.3% by Schirmer’s test, 8.6% by tear film breakup time, 1.5% by fluorescein staining, 7.4% with two or more signs, and 5.5% with any severe symptom not attributed to hay fever. Women were more likely to report severe symptoms of dry eye (odds ratio [OR] = 1.85; 95% confidence limits [CL] = 1 .Ol, 3.41). Risk factors for two or more signs of dry eye include age (OR = 1.04; 95% CL = 1 .Ol, 1.06), and self-report of arthritis (OR = 3.27; 95% CL = 1.74, 6.17). These results were not changed after excluding the 21 people (2.27%) who wore contact lenses. Conclusions: These are the first reported population-based data of dry eye in Australia. The prevalence of dry eye varies by sign and symptom. Ophthalmology 7998; 705:7 7 74- 7 7 79 Dry eye, or keratoconjunctivitis sicca (KCS), is a dis- tressing problem for both patients and ophthalmologists. The prevalence of this condition in the community is unknown because patients present for assessment and treatment when the condition is moderate to severe and the symptoms have become intolerable. Even at this stage, the diagnosis may not be made if the ophthalmologist does not perform the diagnostic tests required to detect dry eye. The condition of dry eye is therefore often over- looked and hence underdiagnosed in the population. Available prevalence data have originated from clinics or Originally received: April 23, 1997. Revision accepted: December 1, 1997. ’ University of Melbourne, Department of Ophthalmology, Melbourne, Australia. * LV Prasad Eye Institute, Hyderabad, India. Supported in part by The Victorian Health Promotion Foundation, Mel- bourne, the Ansell Ophthalmology Foundation, Melbourne, the Dorothy Edols Estate, Melbourne, and the National Health and Medical Research Council, including the Sir John Eccles Award to Professor Hugh Taylor, Canberra, Australia. Consumable items for the dry eye examinations were provided by Smith & Nephew, Melbourne, Australia, and Alcon Australia, Sydney, Australia. Reprints requests to Cathy A. McCarty, PhD, MPH, University of Mel- bourne, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, 32 Gisbome Street, East Melbourne, VIC 3002, Australia. hospitals and thus comprise a select group of patients who are not representative of the population in general.’ The diagnosis of dry eye is often difficult because of a lack of sufficiently discriminatory clinical diagnostic techniques that provide consistent and unambiguous val- ues.2-5 In the milder form of the disease,diagnosis de- pends on cumulative evidence gathered from performing a variety of diagnostic methods. Performing a battery of tests to diagnose a single diseaseis not always possible or feasible. It would, therefore, be convenient to know which of the available tests is most accurate and reliable and consistent with subjective symptoms of dry eye. The purpose of this study was to describe the epidemi- ology of dry eye in the Melbourne population aged 40 years and over. Materials and Methods Study Population Details of the Melbourne Visual Impairment Project (Melbourne VIP) have been described previously.6 This study comprised residents at two testsites of the Melbourne VIP (28% of thetotal study population). Eligible residents were identified through a private household census. To be eligible, a resident had to be 40 years of age or older at the end of the current calender year and a resident at the address for at least 6 months. Eligible residents were invited to attend a local examination center. 1114