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EW FEATURE 56 Dry eye disease update • November 2017 AT A GLANCE • The TFOS DEWS II reports have a wide audience, including the cornea/ external disease specialist, the comprehensive ophthalmologist, the clinical or basic researcher, and the pharmaceutical industry representative. • Changes to the 2007 TFOS DEWS include important updates to the definition and classification of dry eye. • The 11 reports can be read in full or dissected piecemeal depending on a physician's area of interest. • Condensed ways to read the reports include going through the abstracts or conclusion/summaries, download- ing each report's images/figures, or reading the Executive Summary. by Liz Hillman EyeWorld Staff Writer The latest reports from the Tear Film & Ocular Surface Society International Dry Eye Workshop can be read in full or in pieces, depending on a physician's needs T he Tear Film & Ocular Sur- face Society (TFOS) Interna- tional Dry Eye Workshop II (DEWS) unveiled its TFOS DEWS II reports in July. 1 Universal takeaways While individuals might pick and choose to read certain sections that are more relevant to their specialty, purpose, or specific situation, the experts interviewed for this article think there are a few key points everyone should know from TFOS DEWS II. This includes the updated definition of dry eye as follows: 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 abnor- malities play etiological roles. Dr. Nelson, senior medical direc- tor for specialty care, HealthPartners Medical Group and Clinics, St. Paul, Minnesota, said this definition is based on the most current litera- ture-based pathophysiology. He add- ed that the Definition and Classifi- cation Report within TFOS DEWS II specifically defines the terms, based on literature evidence, within this definition. As Dr. Akpek, professor, Johns Hopkins University School of Medicine, Baltimore, explained it, this definition, instead of including decreased secretion and increased evaporation, includes "loss of ho- meostasis," which she said is broader and more accurate because evapora- The sequel to the original TFOS DEWS 2 is more than twice as long, providing an even more in-depth look at the various aspects of dry eye disease (DED) and updates based on new understandings, discoveries, and innovations that have occurred within the last 10 years. The 2017 TFOS DEWS II is the result of 12 subcommittees composed of 150 experts from 23 countries and more than 2 years of effort. The 2007 TFOS DEWS, in comparison, was a 140-page report composed by seven subcommittees with 58 experts. At the outset of the TFOS DEWS II, Anat Galor, MD, staff physician, Miami VAMC, and professor of clin- ical ophthalmology, Bascom Palmer Eye Institute, Miami, said there was discussion of whether TFOS DEWS II should include everything in one massive report or if it should be condensed. In the end, she said, the report "met somewhere in the middle but opted more toward in- clusiveness." TFOS DEWS II consists of 11 individual reports—Introduction, Definition and Classification Report, Sex, Gender, and Hormones Report, Epidemiology Report, Tear Film Report, Pain and Sensation Report, Pathophysiology Report, Iatrogenic Dry Eye Report, Diagnostic Meth- odology Report, Management and Therapy Report, and Clinical Trial Design Report—which in totality add up to 387 pages. An article on page 30 of this issue of EyeWorld —"An updated look at dry eye dis- ease"—addresses in more detail the goals of TFOS DEWS II and some of the important updates. "A new review based on the past 10 years of publications was needed to update the first report and pull together all of the up-to- date knowledge into a compendium of reports that would define that current state of knowledge and dry eye disease," said J. Daniel Nelson, MD, chair of the Steering Commit- tee and member of the Definition and Classification Subcommittee. "In addition, there have been many new diagnostic tools and therapies that have been introduced that need to be evaluated and reviewed." But how is one supposed to read and apply this in-depth re- port? That's what the experts—Dr. Galor, Dr. Nelson, Esen Akpek, MD, Steering Committee mem- ber and member of the Definition and Classification Subcommittee, Christopher Starr, MD, member of the Public Awareness and Education Subcommittee, Preeya Gupta, MD, member of the Diagnostic Method- ology Subcommittee, and David A. Sullivan, PhD, Steering Committee organizer, chair of the Sex, Gender, and Hormones Subcommittee, and chair of the Industry Liaison Sub- committee who consulted on TFOS DEWS II—discuss here. How to read TFOS DEWS II and apply to practice Monthly Pulse Dry eye disease update Prior to cataract surgery, I will: Assess the cornea and/or conjunctiva for fluorescein staining Evaluate the meibomian glands by gentle pressure on the lids Measure the tear film breakup time and tear meniscus All of the above None of the above In my practice, I currently use (select all that apply): EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send an online survey covering different topics so readers can see how they compare to our survey. If you would like to join the physicians who take a minute a month to share their views, please send us an email and we will add your name. Email carly@eyeworld.org and put "EW Pulse" in the subject line. Dry eye questionnaire (i.e., SPEED, OSDI, SANDE, etc.) MMP-9 testing Tear film osmolarity Meibography

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