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Rethinking dry eye disease: a perspective on clinical implications.
Anthony J Bron1, Alan Tomlinson2, Gary N Foulks3
1Professor emeritus - University of Oxford, Nuffield Laboratory of Ophthalmology, Nuffield Dept of Clinical Neurosciences, UK.
The Ocular Surface
|April 15, 2014
Summary
Rethinking dry eye disease (DED) is necessary due to new evidence. Elevated tear osmolarity is a key diagnostic marker, improving patient outcomes and management strategies for this heterogeneous condition.
Area of Science:
- Ophthalmology
- Dry Eye Disease Research
Background:
- The 2007 DEWS report defined dry eye disease (DED) science.
- Recent evidence necessitates a re-evaluation of traditional DED concepts, epidemiology, and diagnostic strategies.
- DED is a heterogeneous condition with significant presentation variability.
Purpose of the Study:
- To summarize recent advances in DED understanding, diagnosis, and clinical care.
- To highlight the limitations of current diagnostic signs and symptoms.
- To discuss the implications of new findings for managing DED.
Main Methods:
- Review of current scientific evidence on DED epidemiology and diagnosis.
- Analysis of the correlation between DED signs, symptoms, and objective measures.
- Evaluation of tear osmolarity as a diagnostic marker.
- Discussion of emerging markers and future research directions.
Main Results:
- Traditional DED signs show poor correlation with each other and symptoms.
- Less than 60% of subjects with objective DED evidence are symptomatic, indicating potential underdiagnosis.
- Elevated tear osmolarity is a reliable global marker for DED diagnosis and severity.
- Tear film instability is a key identifier of DED and emphasizes its bilateral nature.
- Tear osmolarity normalizes with effective treatment, reducing inter-eye variability.
Conclusions:
- Accurate DED recognition is now achievable, improving patient management.
- Elevated tear osmolarity is the most effective single metric for DED diagnosis.
- New diagnostic tests and technologies promise improved clinical trial endpoints and therapeutics.
- Addressing DED heterogeneity and diagnostic challenges is crucial for optimal patient outcomes.
Keywords:
aqueous-deficient dry eye diseasedry eye diseaseinflammationmeibomian gland dysfunctionosmolaritypoint-of-care testingMore Related Videos
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