DED and the Dunedin Study (1)

The Dunedin Multidisciplinary Health and Development Study (Dunedin Study) is a large longitudinal study investigating human health, development, ageing and behaviour, which tracks a population-representative birth cohort born between 1972 and 1973 in Dunedin, New Zealand.


In the current phase, participants were assessed at the age of 45 and, for the first time, underwent a comprehensive dry eye evaluation. The reports from the recent global consensus Tear Film and Ocular Surface Society’s second dry eye workshop (TFOS DEWS II) noted the significant shortage of epidemiological data from the southern hemisphere on the prevalence and risk factors of dry eye disease, thus the Dunedin Study is ideally placed to address some of these gaps in the current dry eye literature.


The recently published results from the dry eye arm of the Dunedin Study showed that the prevalence of dry eye disease was 9% in these 45-year-old New Zealanders1. The prevalence rate was comparable to those reported by the meta-analysis conducted by the TFOS DEWS II epidemiology subcommittee, which highlighted that, globally, dry eye disease was present in between 8 and 15% of 40 to 49-year-old adults2. Among those with dry eye disease in the Dunedin Study cohort, a significant majority (82%) had meibomian gland dysfunction, while just over one quarter (28%) had aqueous tear deficiency, which is also consistent with previous studies that report meibomian gland dysfunction to be the predominant contributor to dry eye disease worldwide3,4. Interestingly, a considerable proportion (37%) of the study cohort exhibited asymptomatic ocular surface disease which may, potentially, represent an opportunity for the introduction of preventative public health strategies. In line with the trends reported by earlier studies¹, female participants in the Dunedin Study cohort were more likely to be afflicted with dry eye disease, meibomian gland dysfunction and asymptomatic ocular surface disease than their male counterparts.


Future planned analysis of the Dunedin Study will involve examination of the potential associations and interactions between mental health, systemic medical conditions and dry eye disease to facilitate further characterisation of modifiable and non-modifiable risk factors for the development of dry eye disease. The investigation of the relationship between human health, development, ageing and dry eye disease will also enable further exploration of whether ocular surface and tear film parameters might serve as biomarkers for the ageing process.




We are indebted to the study team and to the study members for their contribution to this research and are grateful to the Rapanui Trust (Gisborne) for supporting the purchase of the Oculus Keratograph 5M.



  1. Craig JP, Wang MTM, Ambler A, Cheyne K, Wilson GA. Characterising the ocular surface and tear film in a population-based birth cohort of 45-year old New Zealand men and women. Ocul Surf 2020 Aug 13; doi: 10.1016/j.jtos.2020.08.005. Online ahead of print.
  2. Stapleton F, Alves M, Bunya VY, Jalbert I, Lekhanont K, Malet F, et al. TFOS DEWS II Epidemiology Report. Ocul Surf. 2017;15:334-65.
  3. Rabensteiner DF, Aminfar H, Boldin I, Schwantzer G, Horwath-Winter J. The prevalence of meibomian gland dysfunction, tear film and ocular surface parameters in an Austrian dry eye clinic population. Acta Ophthalmol. 2018;96:e707-e11.
  4. Rege A, Kulkarni V, Puthran N, Khandgave T. A clinical study of subtype-based prevalence of dry eye. J Clin Diagn Res. 2013;7:2207-10.


Dr Michael Wang is currently a clinical research fellow and PhD student at the University of Auckland, Dr Graham Wilson is a Gisborne-based ophthalmologist and principal investigator for all eye-related matters on the Dunedin Study and A/Prof Jennifer Craig is an associate investigator on the Dunedin study, based at the Ocular Surface Laboratory at the University of Auckland.


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