{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:33:32Z","timestamp":1787016812704,"version":"build-2736575974"},"reference-count":52,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2022,11,26]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/aims<\/jats:title>\n                    <jats:p>To compare dry eye disease (DED) signs and symptoms between men and women, as well as between premenopausal and postmenopausal women, in the Dry Eye Assessment and Management (DREAM) study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>434\u2009women and 101 men self-reported prior medical history and underwent a standardised DED assessment using the Ocular Surface Disease Index, Brief Pain Inventory, Tear Break-Up Time (TBUT)(s), Schirmer\u2019s test 2 (mm\/5\u2009min), National Eye Institute-graded lissamine conjunctival staining, corneal staining, meibomian gland dysfunction evaluation and tear osmolarity (mOsms\/L) at baseline, 6 months and 12 months. Multivariable linear regression models were used to compare these scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Women experienced significantly worse DED signs than men with lower Schirmer\u2019s test scores (9.27 vs 12.16; p&lt;0.001), higher corneal staining scores (3.59 vs 2.70; p=0.006) and worse composite DED sign scores (0.52 vs 0.40; p&lt;0.001). Postmenopausal women experienced significantly worse DED signs than premenopausal women with higher corneal staining scores (3.74 vs 2.58, p&lt;0.001), higher conjunctival staining scores (2.80 vs 2.22, p&lt;0.001), higher tear osmolarity (304 vs 299, p=0.004), lower TBUT (3.37 vs 3.93, p=0.047), worse meibomian gland dysfunction (3.05 vs 2.62, p=0.04) and worse composite DED sign scores (0.54 vs 0.42, p&lt;0.001). There were no significant differences in DED symptoms between sex and between premenopausal and postmenopausal women (all p\u22650.08).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the DREAM study, women experienced more severe DED signs than men. Further, postmenopausal women presented with more severe DED signs than premenopausal women. Elucidating these differences may improve DED diagnosis and provide future direction in understanding sex-related differences in DED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT02128763\">NCT02128763<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2022-322238","type":"journal-article","created":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T13:20:27Z","timestamp":1670505627000},"page":"23-29","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Sex-related differences and hormonal effects in the Dry Eye Assessment and Management (DREAM) study"],"prefix":"10.1136","volume":"108","clinical-trial-number":[{"clinical-trial-number":"nct02128763","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8005-9111","authenticated-orcid":false,"given":"Megan","family":"Zhao","sequence":"first","affiliation":[{"name":"Penn Medicine, Philadelphia, Pennsylvania, USA"},{"name":"Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3820-1257","authenticated-orcid":false,"given":"Yinxi","family":"Yu","sequence":"additional","affiliation":[{"name":"Penn Medicine, Philadelphia, Pennsylvania, USA"},{"name":"Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA"},{"name":"Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeta S","family":"Roy","sequence":"additional","affiliation":[{"name":"Ophthalmology, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5752-1355","authenticated-orcid":false,"given":"Gui-shuang","family":"Ying","sequence":"additional","affiliation":[{"name":"Penn Medicine, Philadelphia, Pennsylvania, USA"},{"name":"Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA"},{"name":"Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penny","family":"Asbell","sequence":"additional","affiliation":[{"name":"Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vatinee Y","family":"Bunya","sequence":"additional","affiliation":[{"name":"Penn Medicine, Philadelphia, Pennsylvania, USA"},{"name":"Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,12,8]]},"reference":[{"key":"2026011304301015000_108.1.23.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2017.05.008"},{"key":"2026011304301015000_108.1.23.2","first-page":"733","article-title":"[International dry eye workshop (DEWS). 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