Characteristics and Risk Factors Associated with Diagnosed and Undiagnosed Symptomatic Dry Eye Using a Smartphone Application

Importance: The incidence of dry eye disease has increased; the potential for crowdsource data to help identify undiagnosed dry eye in symptomatic individuals remains unknown. Objective: To assess the characteristics and risk factors associated with diagnosed and undiagnosed symptomatic dry eye using the smartphone app DryEyeRhythm. Design, Setting, and Participants: A cross-sectional study using crowdsourced data was conducted including individuals in Japan who downloaded DryEyeRhythm and completed the entire questionnaire; duplicate users were excluded. DryEyeRhythm was released on November 2, 2016; the study was conducted from November 2, 2016, to January 12, 2018. Exposures: DryEyeRhythm data were collected on demographics, medical history, lifestyle, subjective symptoms, and disease-specific symptoms, using the Ocular Surface Disease Index (100-point scale; scores 0-12 indicate normal, healthy eyes; 13-22, mild dry eye; 23-32, moderate dry eye; 33-100, severe dry eye symptoms), and the Zung Self-Rating Depression Scale (total of 20 items, total score ranging from 20-80, with ≥40 highly suggestive of depression). Main Outcomes and Measures: Multivariate-adjusted logistic regression analysis was used to identify risk factors for symptomatic dry eye and to identify risk factors for undiagnosed symptomatic dry eye. Results: A total of 21394 records were identified in our database; 4454 users, included 899 participants (27.3%) with diagnosed and 2395 participants (72.7%) with undiagnosed symptomatic dry eye, completed all questionnaires and their data were analyzed. A total of 2972 participants (66.7%) were women; mean (SD) age was 27.9 (12.6) years. The identified risk factors for symptomatic vs no symptomatic dry eye included younger age (odds ratio [OR], 0.99; 95% CI, 0.987-0.999, P =.02), female sex (OR, 1.99; 95% CI, 1.61-2.46; P <.001), pollinosis (termed hay fever on the questionnaire) (OR, 1.35; 95% CI, 1.18-1.55; P <.001), depression (OR, 1.78; 95% CI, 1.18-2.69; P =.006), mental illnesses other than depression or schizophrenia (OR, 1.87; 95% CI, 1.24-2.82; P =.003), current contact lens use (OR, 1.27; 95% CI, 1.09-1.48; P =.002), extended screen exposure (OR, 1.55; 95% CI, 1.25-1.91; P <.001), and smoking (OR, 1.65; 95% CI, 1.37-1.98; P <.001). The risk factors for undiagnosed vs diagnosed symptomatic dry eye included younger age (OR, 0.96; 95% CI, 0.95-0.97; P <.001), male sex (OR, 0.55; 95% CI, 0.42-0.72; P <.001), as well as absence of collagen disease (OR, 95% CI, 0.23; 0.09-0.60; P =.003), mental illnesses other than depression or schizophrenia (OR, 0.50; 95% CI, 0.36-0.69; P <.001), ophthalmic surgery other than cataract surgery and laser-assisted in situ keratomileusis (OR, 0.41; 95% CI, 0.27-0.64; P <.001), and current (OR, 0.64; 95% CI, 0.54-0.77; P <.001) or past (OR, 0.45; 95% CI, 0.34-0.58; P <.001) contact lens use. Conclusions and Relevance: This study's findings suggest that crowdsourced research identified individuals with diagnosed and undiagnosed symptomatic dry eye and the associated risk factors. These findings could play a role in earlier prevention or more effective interventions for dry eye disease..