The Dry Eye Zone


TFOS DEWS II... and what it means for you!

What is TFOS DEWS II? Think of it as a sort of Enquire within upon everything about dry eye (almost*, and only if you're nerdy enough).

Here is how the Tear Film and Ocular Surface Society (organizers of the project) describe it: "The TFOS DEWS II Report is available after two and a half years of effort. This massive undertaking involved 150 clinical and basic research experts from around the world, who utilized an evidence-based approach and a process of open communication, dialogue and transparency to achieve a global consensus concerning multiple aspects of dry eye disease. This TFOS DEWS II report is the sequel to the original TFOS DEWS publication of 2007."

So basically, TFOS DEWS II is the 2017 updated dry eye bible for eye doctors. The information in it is the best that science has to offer us right now on virtually every medical dry eye topic.

While the report has been very widely disseminated, transferring knowledge is a far longer, more complex process than distributing documents. Many important and practical parts of that information remain concentrated in the hands of researchers and relatively few specialists. In plain terms, there's an awful lot in the report that your eye doctor probably does not know and may not learn anytime soon. But... maybe you and I can help in some small ways to change that reality.

A lot of the writing I'm currently engaged in (which will make its way into these pages over the course of 2018) is distilling this wonderful resource down for patients. Some of the subreports of TFOS DEWS II are dominated by extremely technical information while others are chock full of information more immediately relevant to patients. But they all contain information we need - and improving the accessibility of that information is my ambition.

We dry eye patients have to advocate aggressively for ourselves at times. A great deal of the information in this report is not known to many eyecare professionals, even many specialists. Bringing new information to our eye doctors is often very helpful to them, to us, and to other patients. The more we know, the better we can make the dry eye world for all of us.

Here's a bird's eye view of what TFOS DEWS II contains:

  1. Introduction - Background of the project, objectives, participants on all the subcommittees, issues, controversies, advancements and more.
  2. Definition and Classification - What IS "dry eye", in all its gory detail.
  3. Sex, Gender, Hormone - All about the huge role these things play in dry eye.
  4. Epidemiology - A personal favorite. How many people get dry eye, who they are, what are the risk factors, and all about the questionnaires used to assess dry eye from the patient's perspective.
  5. Tear Film - For seriously hardened chemistry nerds.
  6. Pain and Sensation - A brand new subreport on matters we badly need new solutions for.
  7. Pathophysiology - Stuff like anatomy, physiology, pathology, and more than you ever wanted to know about the difference between aqueous deficient and evaporative dry eye types. It explains a lot about how dry eye happens and progresses in many different conditions.
  8. Iatrogenic Dry Eye - Another brand new subreport, and one of the most important overall: All the different drugs, devices and surgeries that can cause or worsen dry eye.
  9. Management and Therapy - The real crux: What do we do about dry eye? All the different treatments and management approaches. This monster of a paper has more than 1,000 medical references.
  10. Clinical Trial Design - Digs into the question of why, when so many dry eye treatments have been developed, so very few have failed to achieve FDA approved, and what we can do to improve this abysmal track record.

Follow DryEyeZone on Twitter to read my daily TFOS DEWS II sound bites! (Naturally, I don't speak for TFOS. My views and interpretations are my own!)

* Why "almost"? Because so many of the issues we dry eye patients face are not medical at all. They are practical, emotional, financial. They are things like what questions to ask at an eye appointment, how to communicate our concerns and symptoms to our doctors, how to get the accommodations we need in the workplace, how to manage the out-of-pocket costs of dry eye, how to navigate the depression and anxiety that so often accompany corneal disease and uncontrolled pain, and so many more.