An institutional-based cross-sectional study was conducted among undergraduate students attending the University of West Indies (UWI), Saint Augustine Campus, Trinidad and Tobago from October 2020 to April 2021. The university has approximately 17,035 students and eight faculties including Medical Sciences, Science and Technology, Engineering, Sports, Humanities and Education, Food and Agriculture, Social Sciences, and the Faculty of Law.35 (
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All undergraduate students at UWI Saint Augustine campus made up the study population. All undergraduate students attending the UWI Saint Augustine campus who are between the ages of 18–35 years and gave their consent to take part were included as the study population. But the study excluded students who have not stayed up to a semester as UWI students.
Sample size calculated with Raosoft software considering a population of 17,035 and 95% confidence interval with a 5% margin of error using the formula below: x=Z(c/100)2r(100-r) n=N x/((N-1)E2 + x) E=Sqrt[(N - n) x/n(N-1)] Where n is the sample size, E is the margin of error, N is the population size, r is the fraction of responses that you are interested in, and Z(c/100) is the critical value for the confidence level c. Using the above formula, the calculated sample size was 376. By considering a 10% non-response rate, it increased the final sample size to 415.
The list of all registered students was picked up from the university database and labeled according to their faculties. Google random number generator (
https://stattrek.com/statistics/random-number-generator.aspx), was used to select 415 study participants.
Though the gold standard diagnostic test is debatable, the symptom questionnaire is the most repeatable diagnostic test. There are various questionnaires for the diagnosis of SDED. But, the ocular surface disease index (OSDI) is the best-validated standard questionnaire with 12 questions, having high sensitivity (80%), specificity (79%), and reliability (>0.7 by Cronbach’s α) for discriminating patients with and without SDED.36 The standard OSDI questionnaire was adapted by incorporating factors that affect SDED after the literature review.3 (
link),37–42 (
link) The questionnaire was divided into three sections: the first evaluated the frequency of symptoms; the second evaluated the effect of symptoms on daily tasks; and the third evaluated the effect of environmental factors, such as windy conditions and air conditioning. The scores on the three sections were summed up to get the final OSDI score (sum of the 12 questions multiplied by 25 and divided by 12), which ranged from 0 to 100, with higher values indicating symptom severity. Symptomatic dry eye was defined as an OSDI score ≥13.43 (
link) Because of Covid-19 pandemic restrictions, online data collection was the method used to collect data. The student’s contact was obtained from the university database. Consent sheets and questionnaire forms were sent out to those students with their email. Following getting the consent email, research investigators sent the questionnaire link to each student.
The dependent variable was symptomatic dry eye disease and explanatory variables were age, sex, ethnicity, previous ocular surgery, refractive error, smoking, total VDU use hour per day, consistent near work, use of systemic medications, an omega-3 supplement, family history of dry eye, education about dry eye and protective cover of VDUs.
Collected data downloaded from browsers and checked for completeness and consistency before merging with Microsoft Excel 2010. Finally, merged data was exported to SPSS version 20.0, to clean, code, and analyzed. The prevalence of symptomatic dry eye with 95% confidence interval (CI) was determined by using the OSDI score. Descriptive components summarized were frequency, percent, and summary statistics. Binary logistic regression model was fitted and variables with a p-value less than 0.2 with bi-variable analysis were considered for the multivariable analysis. In multivariable logistic regression, explanatory variables with a value of p < 0.05 were significant. Odds ratios (OR) and 95% confidence intervals were calculated to determine the magnitude of association. Hosmer–Lemeshow test was used to assess the model fitness.
SDED was defined as symptomatic dry eye disease with OSDI score ≥13.42 (
link) VDU use hour was defined as the average continuous hours of visual display unit use like a computer, television, and smartphones per day.20 (
link),21 (
link) Current smoking was defined as a daily smoker who smokes any tobacco product at least once a day within the last week.39 (
link) Previous ocular surgery was defined as a history of ocular surgery within the last 1 year.44
Ethical approval was obtained from the University of the West Indies, Saint Augustine campus, Research and Ethics Committee (Registration number: CREC-SA.0721/01/2021). The study followed the tenets of the Declaration of Helsinki.
Ezinne N., Alemu H.W., Cheklie T., Ekemiri K., Mohammed R, & James S. (2023). High Prevalence of Symptomatic Dry Eye Disease Among University Students During the COVID-19 Pandemic in University of West Indies, Trinidad and Tobago. Clinical Optometry, 15, 37-43.