The new definition for dry eye disease (DED) was the last section finalized for the recently released, landmark 2017 Report of the TFOS International Dry Eye Workshop ll, known as DEWS ll.
The definition, which has generated keen interest, was informed by the work of all the subcommittees that contributed to DEWS ll. The entire report is twice as long as its predecessor a decade ago, no doubt due to the number of research articles on the subject doubling in that time.
"The whole report is an evidence-based report of the status of dry eye as we know it right now," says Kelly Nichols, O.D., M.P.H., Ph.D., who served as co-chair of the report's subcommittee on definition and classification.
"That means the statements in the report are informed by what's been published in the literature, forward-looking interpretation based on clinical experiences, Dr. Nichols adds. "We just really hope that all this work raises clinicians' and patients' awareness around the diagnosis and management of dry eye.
"If it's anything like the original DEWS report (published in 2007), it will withstand the test of time and it will be highly cited and downloaded." Dr. Nichols adds. "People will be using it for a variety of different reasons, and it is what clinicians and scientists do with it that will matter."
Defining dry eye
The definition has come a long way, says Dr. Nichols, dean of the University of Alabama at Birmingham School of Optometry who served on the board of directors of the Tear Film & Ocular Surface Society (TFOS) DEWS ll steering committee, which produced the report.
More than 20 years ago, DED was labeled a "disorder." A decade later, in 2007 when the first DEWS report landed, DED was identified as a disease for the first time. And now it has been tweaked again to reflect the growing mountain of research on the subject. Words and phrases, such as "loss of homeostasis," have been joined as well as a nod given to the potential causes of DED and the ultimate outcome.
From this progress comes a new definition:
"Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles."
Each definition furthers understanding of DED, the report's authors say. Read the full report at tearfilm.org. So, what's in a definition?
"A definition and classification scheme should lead to a pathway toward diagnosis, should tell you what to look for, or ask for in this case, since DED has a strong symptomatic component," Dr. Nichols says. "And if you understand some of the etiology related to the disease, then that also indicates treatment targets. The new classification scheme is patient-centered, and provides a decision tree based on symptoms at the start.
"It's important in helping doctors separate out one ocular surface disease from another," she adds. "It's also important that it helps guide treatment through understanding etiology.
Dr. Nichols is quick to give credit where it is due. She praised the 2½ years and countless hours of work by each of the subcommittee members for DEWS ll and the hundreds, perhaps thousands, of other clinicians and researchers behind the scenes globally who tirelessly contributed to the body of evidence for what she called an "encyclopedia" on dry eye.
Not only does the report have twice as many pages, but also the subjects covered in the reports are equally expanded. Sections in the report are similar to the 2007 report, including the standard but weighty "Pathophysiology," "Management and Therapy" and "Epidemiology" from a decade ago to new subcommittee reports such as "Sex, gender and hormones."
"This is really a labor of love," Dr. Nichols says.
And a labor of medicine.
Read more about dry eye in the May 2017 edition of AOA Focus.
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