Prevalence of Dry Eye syndrome in a South African diabetic paediatric population: a single-centre based case study.

Abstract

Background: Diabetes Mellitus is a chronic condition resulting from elevated blood glucose levels. Timeous intervention is vital as poor management may give rise to serious secondary complications, thereby impacting health status and quality of life of patients. The current incidence of diabetes in South Africa is 8.27%, with an occurrence rate of 0.8/100 000 for the younger population, aged 0 to 14 years. Numerous studies have highlighted the fact that diabetes mellitus affects the ocular surface in terms of tear stability and function. Dry eye syndrome is described as a lack of tears on or around the eye or a decrease in the quality of tears produced. An optimal production of tears ensures that the ocular surface is kept moist and healthy. Literature on the prevalence of dry eye in paediatric patients diagnosed with diabetes is sparse. Aim: To determine the prevalence of dry eye in a group of diabetic children and adolescents/young adults in eThekwini, South Africa. Methods: A mixed method, single-centre-based case study approach was employed. A quantitative approach was used to determine the prevalence of dry eye in children with diabetes, using the following tear function tests; Tear Break-Up Time (TBUT), Phenol Red Thread (PRT) and Tear Film Osmolarity (TFO). A qualitative approach was adopted to understand the dry eye- related signs, symptoms, and visual functions of children with diabetes mellitus, using two dry eye questionnaires, Ocular Surface Disease Index (OSDI) and McMonnies questionnaire. Duration of diabetes was used as a parameter in this study. Statistical data analysis was conducted using R Statistical computing software of the R Core Team, 2020, version 3.6.3 (R Studio, Boston, MA, USA). All inferential statistical analysis tests were be conducted at 5% levels of significance. A p-value of p<0.05 was considered statistically significant. Results: Thirty-seven children with diabetes and forty healthy, age group-matched controls who met the respective inclusion criteria, were enrolled in this study. The results of this study revealed that dry eye syndrome was more common among diabetics, with 40.5% participants being from the diabetic population compared to 10.0% from the control group. TBUT values were significantly reduced among the diabetics (p<0.001) indicating tear film instability. PRT results showed statistical significance (p<0.001) between the two groups and were found to be lower in the study group. TFO values were higher in participants with diabetes. No statistically significant differences were reported between the study and control groups, for both questionnaires. However, detailed question-analysis showed that participants of the control group were more symptomatic to dry eye. No relationship between the duration of diabetes and diagnosis of dry eye was established. Conclusion: Due to the constant increase in the number of children and adolescents diagnosed with diabetes mellitus, knowledge on the characteristics and prevalence of dry eye syndrome in this population has become a necessity. This study contributes to the literature by providing novel dry eye results as well as the prevalence in a select South African population. The findings accentuate a need to create awareness among healthcare practitioners working with children diagnosed with diabetes, to ensure timeous referral of ophthalmic assessment which ideally should include a complete dry eye assessment.