{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T18:42:16Z","timestamp":1763145736095,"version":"3.45.0"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Purpose<\/jats:title>\n Visual symptoms in older people may derive from presbyopia and dry eye (DE) with sex-specific pathology. Previous studies have suggested women may have a greater risk for presbyopia than men of the same age. However, the association between DE, which is more frequent in women, and presbyopia has not been determined. This study explored whether the relationship between DE and the severity of presbyopia differs by sex.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This cross-sectional retrospective cohort study included 1147 bilateral phakic patients, aged from 40 to 55 years (858 women and 289 men). Refraction, near add power at 30\u2009cm, and DE-related clinical parameters (corneal staining score and tear break-up time [BUT]) were compared between the sexes. Correlation analyses and odds ratio comparisons of risk factors for reaching specific near add power (1.00, 1.25, 1.50, and 1.75 D) were performed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Corneal staining and tear break-up time (BUT) were worse in women. Correlation analysis stratified by sex revealed that near add power correlated with age (women: \u03b2\u2009=\u20090.80,\n P<\/jats:italic>\n \u2009<\u20090.01; men: \u03b2\u2009=\u20090.80,\n P<\/jats:italic>\n \u2009<\u20090.01), and astigmatic errors (women: \u03b2\u2009=\u20090.16,\n P<\/jats:italic>\n \u2009<\u20090.01; men: \u03b2\u2009=\u20090.19,\n P<\/jats:italic>\n \u2009<\u20090.01) in both sexes, BUT only in women (\u03b2\u2009= \u22120.10,\n P<\/jats:italic>\n \u2009<\u20090.01), and corneal staining only in men (\u03b2\u2009=\u20090.20,\n P<\/jats:italic>\n \u2009<\u20090.01). Women with short BUT and men with corneal staining were more likely to reach higher near add power.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The current study suggests that men with corneal staining and women with short BUT may need more near add power. These DE-related clinical features are significant factors for presbyopia and should be managed to ameliorate presbyopia-related symptoms.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0334117","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T18:37:28Z","timestamp":1763145448000},"page":"e0334117","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex differences in the severity of presbyopia with dry eye: A cross-sectional retrospective study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9481-0164","authenticated-orcid":true,"given":"Masahiko","family":"Ayaki","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2342-9550","authenticated-orcid":true,"given":"Akiko","family":"Hanyuda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2892-9810","authenticated-orcid":true,"given":"Kazuno","family":"Negishi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"issue":"4","key":"pone.0334117.ref001","doi-asserted-by":"crossref","first-page":"102185","DOI":"10.1016\/j.clae.2024.102185","article-title":"BCLA CLEAR presbyopia: Mechanism and optics","volume":"47","author":"LN Davies","year":"2024","journal-title":"Cont Lens Anterior Eye"},{"issue":"1","key":"pone.0334117.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40123-021-00410-w","article-title":"Classification of Presbyopia by Severity","volume":"11","author":"MB McDonald","year":"2022","journal-title":"Ophthalmol Ther"},{"key":"pone.0334117.ref003","doi-asserted-by":"crossref","first-page":"6440954","DOI":"10.1155\/2023\/6440954","article-title":"Analysis of Daily Visual Habits in a Presbyopic Population","volume":"2023","author":"F Ribeiro","year":"2023","journal-title":"J Ophthalmol"},{"issue":"4","key":"pone.0334117.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0250087","article-title":"Sleep and subjective happiness between the ages 40 and 59 in relation to presbyopia and dry eye","volume":"16","author":"K Negishi","year":"2021","journal-title":"PLoS One"},{"issue":"8","key":"pone.0334117.ref005","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1136\/bjo-2024-325887","article-title":"Change in subjective well-being and the associated costs of a woman-targeted presbyopia correction programme among older craftswomen in Zanzibar: a cost-outcome and scenario analysis","volume":"109","author":"VF Chan","year":"2025","journal-title":"Br J Ophthalmol"},{"issue":"6","key":"pone.0334117.ref006","doi-asserted-by":"crossref","first-page":"3215","DOI":"10.1167\/iovs.12-9791","article-title":"Meta-analysis of sex differences in presbyopia","volume":"53","author":"A Hickenbotham","year":"2012","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0334117.ref007","doi-asserted-by":"crossref","first-page":"8159669","DOI":"10.1155\/2022\/8159669","article-title":"Short Tear Breakup Time Could Exacerbate the Progression of Presbyopia in Women","volume":"2022","author":"M Ayaki","year":"2022","journal-title":"Biomed Res Int"},{"issue":"12","key":"pone.0334117.ref008","doi-asserted-by":"crossref","first-page":"2731","DOI":"10.1007\/s10792-019-01117-5","article-title":"Population-based study on the epidemiology of dry eye disease and its association with presbyopia and other risk factors","volume":"39","author":"ELC Mai","year":"2019","journal-title":"Int Ophthalmol"},{"key":"pone.0334117.ref009","doi-asserted-by":"crossref","first-page":"856999","DOI":"10.3389\/fpubh.2022.856999","article-title":"Starting Time of Presbyopic Eyeglasses Wear and Lifestyle","volume":"10","author":"M Ayaki","year":"2022","journal-title":"Front Public Health"},{"issue":"11","key":"pone.0334117.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0259142","article-title":"Presbyopia developed earlier during the COVID-19 pandemic","volume":"16","author":"K Negishi","year":"2021","journal-title":"PLoS One"},{"issue":"5","key":"pone.0334117.ref011","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1097\/00006324-198605000-00009","article-title":"Bifocal adds and environmental temperature","volume":"63","author":"IK Kragha","year":"1986","journal-title":"Am J Optom Physiol Opt"},{"issue":"1","key":"pone.0334117.ref012","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jtos.2016.09.003","article-title":"New Perspectives on Dry Eye Definition and Diagnosis: A Consensus Report by the Asia Dry Eye Society","volume":"15","author":"K Tsubota","year":"2017","journal-title":"Ocul Surf"},{"issue":"2","key":"pone.0334117.ref013","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.jtos.2016.11.003","article-title":"Visual acuity and quality of life in dry eye disease: Proceedings of the OCEAN group meeting","volume":"15","author":"J Ben\u00edtez-Del-Castillo","year":"2017","journal-title":"Ocul Surf"},{"issue":"4","key":"pone.0334117.ref014","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1136\/bjophthalmol-2015-308237","article-title":"Functional impairment of reading in patients with dry eye","volume":"101","author":"PM Mathews","year":"2017","journal-title":"Br J Ophthalmol"},{"key":"pone.0334117.ref015","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.ajo.2019.10.009","article-title":"Sustained Gazing Causes Measurable Decline in Visual Function of Patients with Dry Eye","volume":"210","author":"EK Akpek","year":"2020","journal-title":"Am J Ophthalmol"},{"key":"pone.0334117.ref016","article-title":"Mechanisms of Visual Disturbance in Dry Eye","author":"S Koh","year":"2016","journal-title":"Cornea"},{"issue":"11","key":"pone.0334117.ref017","doi-asserted-by":"crossref","first-page":"2995","DOI":"10.1007\/s10792-020-01483-5","article-title":"Evaluation of objective visual quality in dry eye disease and corneal nerve changes","volume":"40","author":"J Ma","year":"2020","journal-title":"Int Ophthalmol"},{"issue":"5","key":"pone.0334117.ref018","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/S0002-9394(02)02147-5","article-title":"Improved functional visual acuity after punctal occlusion in dry eye patients","volume":"135","author":"E Goto","year":"2003","journal-title":"Am J Ophthalmol"},{"issue":"2","key":"pone.0334117.ref019","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/s12325-019-01188-x","article-title":"Long-Term Safety and Effectiveness of Diquafosol for the Treatment of Dry Eye in a Real-World Setting: A Prospective Observational Study","volume":"37","author":"Y Ohashi","year":"2020","journal-title":"Adv Ther"},{"issue":"12","key":"pone.0334117.ref020","doi-asserted-by":"crossref","first-page":"2471","DOI":"10.1016\/j.ophtha.2012.06.052","article-title":"Rebamipide (OPC-12759) in the treatment of dry eye: a randomized, double-masked, multicenter, placebo-controlled phase II study","volume":"119","author":"S Kinoshita","year":"2012","journal-title":"Ophthalmology"},{"issue":"5","key":"pone.0334117.ref021","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1046\/j.1475-1313.1995.9500059m.x","article-title":"Broken down by age and sex. The optical correction of presbyopia revisited","volume":"15","author":"JS Pointer","year":"1995","journal-title":"Ophthalmic Physiol Opt"},{"issue":"2","key":"pone.0334117.ref022","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1046\/j.1475-1313.2002.00012.x","article-title":"Gender-related optical aspects of the onset of presbyopia","volume":"22","author":"JS Pointer","year":"2002","journal-title":"Ophthalmic Physiol Opt"},{"issue":"4","key":"pone.0334117.ref023","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1097\/00006324-194904000-00003","article-title":"A survey of practices in prescribing presbyopic adds","volume":"26","author":"HW Hofstetter","year":"1949","journal-title":"Am J Optom Arch Am Acad Optom"},{"issue":"1","key":"pone.0334117.ref024","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/opo.12244","article-title":"Age and the amplitude of accommodation measured using dynamic retinoscopy","volume":"36","author":"A Le\u00f3n","year":"2016","journal-title":"Ophthalmic Physiol Opt"},{"issue":"3","key":"pone.0334117.ref025","doi-asserted-by":"crossref","first-page":"255","DOI":"10.5674\/jjppp1983.25.255","article-title":"Age and gender differences in endogenous eyeblinks and the standard blink rate of normal adults [in Japanese]","volume":"25","author":"T Sugiyama","year":"2007","journal-title":"Jpn J Physiol Psychol and Psychophysiol"},{"key":"pone.0334117.ref026","doi-asserted-by":"crossref","first-page":"861","DOI":"10.2147\/OPTH.S128939","article-title":"Severe symptoms of short tear break-up time dry eye are associated with accommodative microfluctuations","volume":"11","author":"M Kaido","year":"2017","journal-title":"Clin Ophthalmol"},{"issue":"2","key":"pone.0334117.ref027","doi-asserted-by":"crossref","DOI":"10.1530\/JOE-14-0349","article-title":"Oestrogen, ocular function and low-level vision: a review","volume":"223","author":"CV Hutchinson","year":"2014","journal-title":"J Endocrinol"},{"issue":"4","key":"pone.0334117.ref028","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1016\/S0161-6420(96)30637-4","article-title":"Tear flow and evaporation in patients with and without dry eye","volume":"103","author":"WD Mathers","year":"1996","journal-title":"Ophthalmology"},{"issue":"2","key":"pone.0334117.ref029","doi-asserted-by":"crossref","first-page":"363","DOI":"10.2466\/pms.1994.78.2.363","article-title":"Implications for dynamic visual acuity with changes in aged and sex","volume":"78","author":"H Ishigaki","year":"1994","journal-title":"Percept Mot Skills"},{"issue":"6","key":"pone.0334117.ref030","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1167\/iovs.63.6.20","article-title":"Characteristics of the Optic Nerve Head in Myopic Eyes Using Swept-Source Optical Coherence Tomography","volume":"63","author":"D Cheng","year":"2022","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"11","key":"pone.0334117.ref031","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1001\/archinte.161.11.1448","article-title":"Postmenopausal estrogen use, type of menopause, and lens opacities: the Framingham studies","volume":"161","author":"K Worzala","year":"2001","journal-title":"Arch Intern Med"},{"issue":"1","key":"pone.0334117.ref032","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1073\/pnas.1912546116","article-title":"Ultraviolet A light induces DNA damage and estrogen-DNA adducts in Fuchs endothelial corneal dystrophy causing females to be more affected","volume":"117","author":"C Liu","year":"2020","journal-title":"Proc Natl Acad Sci U S A"},{"key":"pone.0334117.ref033","first-page":"1","article-title":"Hunting of the Boyela, slash-and-burn agriculturalists, in the central Zaire Forest","volume":"4","author":"H Sato","year":"1983","journal-title":"African Study Monographs"},{"issue":"10","key":"pone.0334117.ref034","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1001\/archopht.1995.01100100054027","article-title":"Ocular surface changes and discomfort in patients with meibomian gland dysfunction","volume":"113","author":"J Shimazaki","year":"1995","journal-title":"Arch Ophthalmol"},{"key":"pone.0334117.ref035","doi-asserted-by":"crossref","DOI":"10.1016\/j.ophtha.2017.05.031","article-title":"Meibomian Gland Disease: The Role of Gland Dysfunction in Dry Eye Disease","volume":"124","author":"P Chhadva","year":"2017","journal-title":"Ophthalmology"},{"issue":"3","key":"pone.0334117.ref036","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.annepidem.2010.10.003","article-title":"Androgen deprivation therapy and cataract incidence among elderly prostate cancer patients in the United States","volume":"21","author":"J Beebe-Dimmer","year":"2011","journal-title":"Ann Epidemiol"},{"issue":"1","key":"pone.0334117.ref037","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/OPX.0000000000001627","article-title":"Subjective Evaluation of Defocus and Astigmatism Combinations Using Image Simulation in Presbyopes","volume":"98","author":"M Vincent","year":"2021","journal-title":"Optom Vis Sci"},{"issue":"1","key":"pone.0334117.ref038","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1136\/bjophthalmol-2013-303066","article-title":"Influence of additional astigmatism on distance-corrected near visual acuity and reading performance","volume":"98","author":"M Casagrande","year":"2014","journal-title":"Br J Ophthalmol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0334117","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T18:37:33Z","timestamp":1763145453000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0334117"}},"subtitle":[],"editor":[{"given":"Timo","family":"Eppig","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,14]]},"references-count":38,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0334117","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,14]]}}}