Prevalence of dry eye disease in visual display terminal workers: a systematic review and meta-analysis

OBJECTIVE To evaluate the prevalence and risk factors of dry eye disease (DED) in workers using visual display terminals (VDT). DESIGN Systematic review and meta-analysis. DATA SOURCES We searched PubMed, Cochrane Library, Embase and Science Direct databases for studies reporting DED prevalence in VDT workers. RESULTS 16 of the 9049 identified studies were included, with a total of 11,365 VDT workers. Despite a global DED prevalence of 49.5% (95% CI 47.5 to 50.6), ranging from 9.5% to 87.5%, important heterogeneity (I(2)=98.8%, p<0.0001) was observed. Variable diagnosis criteria used within studies were: questionnaires on symptoms, tear film anomalies and corneoconjunctival epithelial damage. Some studies combined criteria to define DED. Heterogeneous prevalence was associated with stratifications on symptoms (I(2)=98.7%, p<0.0001), tears (I(2)=98.5%, p<0.0001) and epithelial damage (I(2)=96.0%, p<0.0001). Stratification of studies with two criteria adjusted the prevalence to 54.0% (95% CI 52.1 to 55.9), whereas studies using three criteria resulted in a prevalence of 11.6% (95% CI 10.5 to 12.9). According to the literature, prevalence of DED was more frequent in females than in males and increased with age. CONCLUSIONS Owing to the disparity of the diagnosis criteria studied to define DED, the global prevalence of 49.5% lacked reliability because of the important heterogeneity. We highlight the necessity of implementing common DED diagnostic criteria to allow a more reliable estimation in order to develop the appropriate preventive occupational actions.