Long-Term Trends In Dry Eye Disease Treatment In South Korea: A Nationwide Population-Based Analysis Using National Health Insurance Claims Data (2014–2023)

To evaluate long-term trends in the prevalence of dry eye disease (DED) and changes in pharmacological treatment patterns in South Korea using a nationwide claims database, with a focus on age-, sex-, and formulation-specific prescribing pattern.

Nationwide, population-based study using a customized National Health Insurance Service (NHIS) claims database in South Korea, based on a mandatory universal insurance system covering nearly the entire population.

We conducted a retrospective analysis of NHIS claims from 2014 to 2023. Patients were defined as having DED if they had at least one relevant ICD-10 diagnosis (H04.11, H16.1, H16.13, H16.18, H16.2, M35.0) and at least one prescription for DED-related topical medication. Annual prevalence was calculated using national census data as the denominator. Prescriptions were categorized into six pharmacological classes: hyaluronic acid (HA), carboxymethylcellulose (CMC), diquafosol, rebamipide, povidone, and cyclosporine. Temporal trends in drug class distribution, single-use versus multiuse formulations, and the mean number of distinct prescribed drug classes per patient were analyzed.

Between 2014 and 2023, approximately 9.87 million patients with treated DED were identified. Annual prevalence increased from about 5.0% in 2014 to 5.5% in 2023 and was consistently higher in women and older age groups. HA remained the most prescribed agent (81.4%), followed by diquafosol (8.6%) and CMC (4.6%). Over time, prescriptions of cyclosporine and mucin secretagogues increased, whereas the relative share of HA and CMC declined. The proportion of single-use formulations rose steadily, particularly among younger patients, while older patients more frequently received multiuse preparations. The mean number of prescribed drug classes per patient increased from 1.49 in 2014 to 1.59 in 2023.

This nationwide analysis demonstrates a gradual increase in treated DED prevalence and a clear shift toward anti-inflammatory therapy and single-use formulations over the past decade. The rising number of prescribed drug classes per patient indicates increasing treatment complexity, reflecting evolving clinical practice in DED management and providing real-world evidence relevant to clinical guidelines and health policy.