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EW CORNEA 30 November 2017 by Vanessa Caceres EyeWorld Contributing Writer and treatments with solid scientific evidence to back it up. We are no longer managing a constellation of symptoms but an actual disease." The TFOS DEWS II definition of DED One area of interest with the latest report series is the updated defini- tion of DED. The DEWS 2007 definition was the first to acknowledge dry eye was a disease entity with a multifactorial etiology, according to the TFOS DEWS II definition re- port. 2 However, the researchers note that the definition did not include information on the etiology of DED, particularly increased osmolarity and inflammation. A survey of TFOS DEWS II membership in late 2015 found that 77% of those who voted thought the definition of DED should be updated. "Specifically, it became clear that TFOS DEWS II members acknowledged the significant role of inflammation and hyperosmo- larity within the DED pathway, but challenged inclusion of those precise terms in the definition, due to a percept that clinical demonstration of these pathophysiological features was required to validate a diagnosis of dry eye," report authors wrote. Members of the Definition and Classification Subcommittee wanted to acknowledge that a loss of tear film homeostasis can be caused by many factors that relate to eyelid and blink abnormalities. "These changes can induce focal or global tear film instability and tear hyperosmolarity in response to excessive evaporation from the ocular surface, and are regarded as significant entry points that contrib- ute to the pathogenesis and perpetu- ation of a cycle of events, or 'Vicious Circle,' in DED," they wrote. Another component that subcommittee members wanted to address is the mounting evidence from the past decade regarding the potential role for neurosensory abnormalities in the understanding of DED. These considerations led to the updated definition. The Definition and Classifica- tion Report for DED also aimed to connect aqueous deficient and evap- orative dry eye disease on a continu- um rather than as separate entities. The TFOS DEWS II reports will be offered in French, Italian, German, Spanish (sponsored by Allergan, Dublin, Ireland), Chinese, Korean, Portuguese, Vietnamese (sponsored by Novartis, Basel, Swit- zerland), Romanian, and Turkish (sponsored by SIFI, Rome, Italy), according to the journal. The reports offer a comprehen- sive look at DED, from an updated definition to treatment to iatrogenic dry eye and epidemiology, among other topics. All of the reports are evidence-based. Members of various TFOS DEWS II subcommittees met several times across the globe to finalize their work. "My suggestion is that the Defi- nition and Classification Report be read first, followed by the Diagnostic Methodology and the Management and Therapy Reports," Dr. Nelson said. "The Iatrogenic Report provides a great resource on dry eye disease that is induced by patients and clinicians and the therapies and in- terventions that they use. The other reports provide detail on the current state of dry eye disease in 2017." "The take-away from this is that we are much more knowledgeable about the pathogenesis of dry eye disease than we were 10 to 15 years ago," said Inna Ozerov, MD, Miami Eye Institute, Hollywood, Florida. Dr. Ozerov frequently treats dry eye. "At this stage, we are able to coun- sel patients about their condition The latest reports, called TFOS DEWS II, were published in the July issue of The Ocular Surface. The reports reflect a 2.5-year effort of 150 TFOS DEWS II members from 23 countries, said J. Daniel Nelson, MD, Department of Oph- thalmology, HealthPartners Medical Group and Clinics, St. Paul, Minne- sota, and TFOS DEWS II chair. The goals set by the TFOS DEWS II Steering Committee were to update the definition, classification, and diagnosis of DED; assess DED's etiology, mechanism, distribution, and impact; and address DED man- agement and therapy. The end result is the 11 reports that appear in The Ocular Surface. A new report series for a comprehensive take on dry eye T he release of the Tear Film and Ocular Surface Society (TFOS) International Dry Eye Workshop (DEWS) reports in 2007 acknowl- edged the growing knowledge that clinicians had about dry eye disease (DED). 1 Fast forward to 2017, and the latest TFOS DEWS reports continue to incorporate ophthalmology's growing research and understanding of dry eye. An updated look at dry eye disease New TFOS DEWS II reports All report names are proceeded with "TFOS DEWS II," and all appear in the July 2017 issue of The Ocular Surface. • Introduction • Definition and Classifica- tion Report • Sex, Gender and Hormones Report • Epidemiology Report • Tear Film Report • Pain and Sensation Report • Pathophysiology Report • Iatrogenic Dry Eye Report • Diagnostic Methodology Report • Management and Therapy Report • Clinical Trial Design Report

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