After almost two and a half years and a massive effort involving 150 clinical and other research experts from around the world, global consensus has finally been reached on the subject of dry eye.

The new Tear Film & Ocular Surface Society, Dry Eye Workshop II report (TFOS DEWS IITM), takes some important steps towards better diagnosis and management of the problem, believes Professor James Wolffsohn, associate pro-vice chancellor and a professor of optometry at Aston University:

"One in three people, over the age of 65, will experience problems with dry eyes."

“Dry eye is often treated as an annoyance, but as the population gets older and does more visually demanding screen-based tasks, the effect of dry eye on people’s health and quality of life will increase. It is already one of the most frequent causes of patient visits to eye care practitioners. That’s why I believe this global initiative is very important.”

 

Who suffers from dry eye?

 

“One of the most intriguing features of dry eye disease is that it occurs more frequently in women than men,” explained Amy Gallant Sullivan, Executive Director, TFOS.

"A person’s chances of developing dry eye disease increases with age, and it is thought that up to one in every three people over the age of 65 will experience problems with dry eyes. However, global studies now suggest that even young people can be affected, with prevalence affected by gender, lifestyle and ethnicity."

 

What actually is dry eye?

 

Tears are made of oily (lipid), watery (aqueous) and sticky (mucous) layers. Various factors can cause a deficiency in one or more of the tear layers leading to dry eye. This is why TFOS DEWS II suggests a structured diagnosis approach to help select the right dry eye therapy.

"As the condition continues and worsens, more damage is done to the eye."

Milder dry eye can manifest as feelings of dryness, grittiness or soreness that can get worse throughout the day. Some people also complain of temporarily blurred vision, which usually improves when you blink.

However, as the condition continues and worsens, more damage is done to the eye. Affected people can find they experience eye fatigue that makes it harder to concentrate on visual activities.

 

 

The challenge of diagnosis and treatment

 

When prescribing treatment for the condition, eye and healthcare professionals face the challenge of isolating the correct single or multiple causes of dry eye from a the list of potential causes that can include:
 

  • being in a natural or artificially dry environment
     
  • wearing contact lenses
     
  • certain underlying medical conditions, such as inflammation of the eyelids or autoimmune diseases
     
  • side effects of common medications such as hayfever remedies
     
  • use of cosmetics and aesthetic procedures such as anti-wrinkle injections or eyelash growth serums
     
  • hormonal changes in women – such as during the menopause, pregnancy, or while using the contraceptive pill.

 

The definitive Dry Eye report

 

Attempting to support them in this challenge, the TFOS DEWS II report committee have now redefined dry eye and reviewed the evidence-based research. The TFOS DEWS II report provides a recommended way to diagnose and manage the condition, and aims to reduce  some of the inherent knowledge gaps such as the effects of hormones and the make-up of the human eye’s tear film. The end goal is to pave the way for more specialised treatments delivered in a more standardised way. Professor Wolffsohn says: “There can be a bit of a ‘one-size-fits’ all approach to management. If we have not understood all the potential causes of dry eye and developed consensus on what is gold-standard care, we will not be optimising personalised treatment. We have to move away from treating people with dry eye as one amorphous group.”

 

TFOS DEWS II is available free, online, at www.tearfilm.org  

 

The TFOS and Novartis collaboration


This article was written in collaboration with TFOS and Novartis. Novartis, a global healthcare company, is a key supporter of TFOS and the DEWS II report. Novartis Ophthalmology is committed to helping people with eye disease see better, feel better and live better.