The updated definition

A decade after the first DEWS report, OT  delves into the newly released official description of dry eye

Hazel eye

A simplified definition of dry eye as well as a new classification system will help optometrists to diagnose and manage the disease, advise the experts behind the latest DEWS report.

The new definition is contained in the Tear Film and Ocular Surface Society Dry Eye Workshop II (DEWS II). More than 150 clinical experts contributed to the initiative, which is a sequel to the original DEWS report published 10 years ago.

Speaking at the 2017 British Contact Lens Conference, DEWS II vice chair, Dr Jennifer Craig, emphasised that the goal of the project was to create an evidence-based definition and classification of dry eye.

The definition contained in the original report was used as a starting point, with researchers reviewing scientific literature published over the past decade to take the definition forward.

"We were tasked with addressing the perceived shortcomings of the classification as it was," Dr Craig explained. 

"There are a whole number of reasons why we need a firm diagnosis...Our principal aim was really to lock this down and say this is how we are going to diagnose dry eye in the future"

"We wanted it to be a single sentence but it needed to be sufficiently specific to be able to differentiate dry eye from other ocular surface conditions," she added. 

Dr Craig explained that the purpose of the new classification system was to ultimately improve patient care. 

"It needed to be applicable and helpful to the clinician," she elaborated. 

The classification system was not intended to override a practitioner's judgement but to guide clinical assessment and future research, Dr Craig emphasised. 

Professor James Wolffsohn, chair of the DEWS II diagnosis subcommittee, highlighted that the new report reduced uncertainty.

"It helps us as clinicians to know what dry eye is and what it isn't," he elaborated. 

It was difficult to calculate global prevalence of dry eye if different countries were using different definitions, Dr Wolffsohn explained. 

"There are a whole number of reasons why we need a firm diagnosis...Our principal aim was really to lock this down and say this is how we are going to diagnose dry eye in the future," he concluded.

Dry eye in focus

The latest news and clinical research shaping the future for patients

Sweet solution

Researchers are investigating using Manuka honey to treat blepharitis. 

The spread, which has anti-inflammatory and antibiotic properties, holds potential for reducing the bacterial load of the eyelid. 

A University of Auckland project using a Manuka honey compound to treat blepharitis has progressed to an efficacy trial with 28 patients recruited to the study. 

Red light therapy gets green light 

Using red light therapy to ease the symptoms of dry eye proved effective in a study presented at the Association for Research and Vision in Ophthalmology annual meeting in Baltimore (7–11 May).

The research measured noninvasive break-up time (NIBUT) before and after treatment with quantum red light technology. A group of 52 patients placed the device over closed eyes for three minutes on each eye at least twice a week. Total treatment duration varied from one to 12 months.

The mean NIBUT increased from 3.82 seconds before red light therapy to 5.87 seconds after treatment.

Commercial cleanser best

Researchers have reported better results using a commercial lid cleanser to treat blepharitis than baby shampoo.

Baby shampoo is used as a home remedy for blepharitis but few studies have tested its effectiveness.

University of Auckland scientists recruited 43 patients with signs of blepharitis as part of a double-masked randomised clinical trial.

The participants applied a commercial lid cleanser to the eyelids of one eye and diluted baby shampoo to the eyelids of the other eye twice daily for four weeks. 

Although improvement was observed in both groups, the commercial cleanser was found to be more effective in improving lipid layer function and reducing inflammation.

Adverse effects were associated with using diluted baby shampoo, including meibomian gland orifice obstruction.

The researchers found that a significantly higher proportion of the participants preferred the eyelid cleanser over the baby shampoo. 

Incomplete blinks to blame?

A greater incomplete blink rate may put Asian populations at a higher risk of developing dry eye, research suggests. 

A New Zealand study observed the influence of eyelid shape on tear film quality, ocular surface characteristics and dry eye symptoms. A group of 74 Asian and Caucasian study participants who were born and raised in New Zealand took part in the research. 

The study found a higher degree of meibomian gland dropout and incomplete blinking among Asian participants, potentially predisposing them to dry eye. 

Spotlight on dry eye

Abayomi Ogundele, Novartis’ external eye diseases worldwide medical affairs director, talks with OT

What impact does dry eye have on everyday life?

Dry eye disease (DED) can have a significant impact on the quality of life of sufferers. Studies have shown that DED can impact simple daily tasks such as driving, reading, computer work, watching television, and so on.

Are there a growing number of dry eye cases? What factors might be influencing this?

It is currently estimated that about 344 million people worldwide suffer from dry eye, with the prevalence rate expected to grow by about 2% annually. Factors influencing the prevalence rate include: the ageing population, increased use of topical ocular medications that can disrupt the homeostasis of the tear film, the higher usage of digital devices which is precipitating dry eye symptoms, a higher rate of contact lens wearers, increases in the number ocular surgical procedures – for example, corrective refractive surgery, eyelid surgery, cataract surgery.

What dry eye solutions does Systane offer and how are they different to other products on the market?

The Systane portfolio offers a number of products to help manage symptoms caused by different types of dry eye. Systane products are the only artificial tear products that contain Hydroxypropyl guar (HP-guar), which is a gellating agent that interacts with other excipients within the formulation upon instillation into the eye to help stabilise the tear film and improve the retention of the formulation on the ocular surface. Each Systane product is uniquely formulated to help replenish the deficiencies within the natural tear film which may be causing the dry eye symptoms.

What role can innovation play in addressing these challenges?

Some of the challenges we face today in the management of dry eye can be addressed through innovative ideas like, creating awareness campaigns to improve knowledge of dry eye disease amongst health care professionals and patients, creating simple dry eye diagnostic tools, availability of better Rx treatment options that can address both signs and symptoms, and simplified artificial tear product options that can address multiple tear film deficiencies in different types of dry eye disease.

Tackling dry eye: the challenges

  • Low awareness amongst health care professionals about the detrimental effect of DED on the ocular surface or exacerbates of dry eye symptoms
  • Clinical diagnostic challenges, particularly with non-dry eye specialists
  • Discerning symptoms of dry eye from symptoms of other ocular diseases (for example, ocular allergy)
  • Little or no correlation between signs and symptoms of dry eye
  • Limited Rx treatment options that are often ineffective or take months before patients see improvements
  • Multiple artificial tear product options to choose from.

Image credit: Getty