TFOS DEWS III updates definitions and diagnostic processes in dry eye

The Tear Film and Ocular Surface Society (TFOS) has released its third set of reports exploring the diagnosis and management of dry eye disease.

The findings of the TFOS DEWS III report were presented publicly for the first time at the BCLA Clinical Conference and Exhibition in Birmingham (5–7 June), where professors James Wolffsohn, Lyndon Jones, Fiona Stapleton, and associate professor Jennifer Craig shared the outcomes of the study.

The open-access reports have been published in the American Journal of Ophthalmology and follow prior versions published in 2017 and 2007.

The TFOS DEWS III report updates the recommendations and conclusions of the former report, regarding the subclassification, diagnostic methodology, and management and therapy of dry eye disease.

The report is divided into three sections, giving guidance for eye care professionals to follow in establishing whether patients have dry eye disease, to find out what is causing it, and outline the best forms of management.

Professor James Wolffsohn, professor and dean of optometry at Aston University, is on the TFOS executive and told OT what readers can expect from TFOS DEWS III, sharing that, with a focus on the definition and diagnosis of dry eye disease, the key change has been: “Instead of just going with aqueous, which is relatively few patients, and evaporative, which is pretty much all patients with dry eye, we’ve broken that up.”

“We’re helping practitioners to look at each layer of the tear film, to look at the lids and blinking, eyelid closure, also ocular surface and all major causes of dry eye, so in an individual patient they can identify the things driving dry eye in that particular patient,” he said.

This could be the lipid layer for one patient, Wolffsohn suggested, with corneal staining and issues of not blinking properly.

“We’ve aligned the evidence of management directly to that. So, they can then say: ‘If I use this drop, that might hit two of the criteria, and if I do a warm compress that will hit the third,’ so we’re helping people to really personalise their treatment for an individual patient,” Wolffsohn said.

He added that this approach should create improvements “in this very broad space where one third of adults and one in five children have dry eye disease.”