Eyeworld

EW FEATURE 58 Dry eye disease update • November 2017 Applying to clinical practice While TFOS DEWS II can add to any reader's knowledge base about the ins and outs of dry eye, the reports can have immediate clinical signif- icance. Dr. Nelson suggested start- ing with the Classification Scheme (Figure 3 in the Definition and Classification Report) to determine whether or not a patient has dry eye or is at risk. "For patients contemplating contact lenses, cataract and intra- ocular lens or refractory surgery, screening with the appropriate tests to rule out patients who may be at risk for developing DED that may result in poor post-surgical visual outcomes is necessary," he said, adding later that the Iatrogenic Report highlights how often clini- cians (through surgical or medical interventions) or the patient (with the use of medications, cosmetics, or environmental exposure) can cause dry eye. What's more, the newer area of clinical focus on neuropathic pain involves patients with symp- toms but no signs of DED, which Dr. Nelson said is often associated with a systemic pain syndrome. The Management and Therapy Report goes into detail about the current treatment options available for various types of DED. "I think the report is a compre- hensive, detailed overview of every- thing we currently know about the complex subject that is DED," Dr. Starr said. "It took me awhile to read the whole thing, and I'm sure I will reread it many times in the years to come. I think every subcommittee is equally important and equally il- luminating. That being said, for the average practitioner who will not read the whole report, I think the Definition and Classification Report, Diagnostic Methodology Report, and Management and Therapy Reports would have the most immediate clinical relevance." EW References 1. TFOS International Dry Eye WorkShop (DEWS II). Ocul Surf. 2017;15:269–650. 2. 2007 report of the International Dry Eye WorkShop. Ocul Surf. 2007;5:65–204. Editors' note: The sources have no financial interests related to their comments. Contact information Akpek: esakpek@jhmi.edu Galor: AGalor@med.miami.edu Gupta: preeya.gupta@duke.edu Nelson: dryeyemd@gmail.com Starr: drstarr@gmail.com Sullivan: David_Sullivan@meei.harvard.edu most information, in addition to reading the abstracts, conclusion/ summaries, and/or the Executive Summary. Her biggest piece of advice: "Start with the figures. You can get a lot of information from the figures. That's a great way to get started, then depending on your interests and information needed, you can read further." The images from each report can be viewed online or downloaded as a PowerPoint without having to scroll through the full report to find each figure. Specific figures Dr. Gupta called out include Figure 3 within the Definition and Classification Report, which presents a schematic on the classification of dry eye; Figure 5 from the Diagnostic Methodology Report, which presents the DED diagnostic algorithm; Figure 5 from the Pathophysiology Report, which depicts the vicious circle of DED; and Figure 12 from the Patho- physiology Report, which shows a schematic of meibomian gland dysfunction. Specialists with an atypical dry eye case, Dr. Gupta said, might benefit from looking at the Pain and Sensation Report, which includes several figures that detail brain and nerve pathways that could result in neurosensory abnormalities, pre- senting as eye pain. in basic research or industry with a brief overview, as could the Exec- utive Summary of TFOS DEWS II, which was published in the October issue of The Ocular Surface. Dr. Starr said he'd encourage every eyecare practitioner to at least read this condensed Executive Summary. How to read TFOS DEWS II If you do not plan to read all the reports, at least to start, and would prefer a piecemeal approach tailored to your needs, Dr. Gupta, associate professor of ophthalmology, Duke University School of Medicine, Durham, North Carolina, offered some thoughts on how to glean the How to continued from page 57

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