Since out last newsletter we have had some great research outputs from SOVS.
Many of our academics were involved in TFOS DEWS II. This was a global effort that involved 150 clinical and basic research experts from 23 countries. These experts reviewed literature to provide an evidence-based global consensus on multiple aspects of this increasingly common disease. There were 10 subcommittees and a steering committee that were tasked with the overall objectives to (1) Update the definition, classification and diagnosis of Dry Eye Disease, (2) Critically assess the aetiology, mechanism, distribution and impact of this disorder, and (3) Address its management and therapy. This process took just over 2 years of intense effort.
The School had members on the following subcommittees: Steering committee (Fiona Stapleton; Mark Willcox); Definition and Classification (Fiona Stapleton); Sex, Gender, Hormone (Blanka Golebiowski, Mark Willcox); Epidemiology Report (Fiona Stapleton, Isabelle Jalbert); Tear Film (Mark Willcox, Eric Papas – and PhD alumnus Ulrike Stahl); Pain and Sensation(Fiona Stapleton); Pathophysiology (Maria Markoulli); Iatrogenic Dry Eye (Post-doc alumnus Nathan Efron); Clinical Trial Design (Fiona Stapleton). Indeed, the only committees in which SOVS was not directly involved were Diagnostic Methodology and Management and Therapy.
Photograph of members of TFOS Board of Directors and Industry Advisory Board who met in Boston in April 2018
The report provides a new definition of Dry Eye Disease as:
“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 abnormalities play etiological roles.”
The Sex, Gender, Hormone report highlighted the major role sex, gender and hormones play in the regulation of ocular surface and adnexal tissues, and in the difference in the prevalence of Dry Eye Disease between women and men.
The Epidemiology Report produced estimates for the prevalence of this disease and showed that prevalence increased between 2.0% (self-report of a clinical diagnosis of dry eye) and 10.5% (based on a positive Schirmer test) by decade. The prevalence of meibomian gland disease increased by 5.3% per decade. The differences in the prevalence of Dry Eye Disease between man and women become most obvious after 50 years of age.
The Pathophysiology subcommittee provided a diagram (TFOS DEWS II Pathophysiology, reproduced below with permission from Elsevier) that outlines factors associated with this disease and highlights the vicious cycle that can exacerbate the disease.
The Vicious Circle of Dry Eye Disease” reprinted from The Ocular Surface Vol 15 2017. Bron AJ. et al
The Tear Film report highlighted ways of measuring tear film stability, made a plea for the development of an instrument to measure tear film evaporation, and showed that new biomarkers (proteins, lipids and mucins) have been discovered that offer improved ways to diagnose the disease, monitor its progress, and measure success of therapies. Dry Eye Disease is associated with ocular pain and dryness sensations.
The Pain and Sensation subcommittee outlined the neuronal basis for this. The report explains that the inflammation associated with Dry Eye Disease causes sensitization of (polymodal and mechano-nociceptor) nerve endings and an abnormal increase in cold thermoreceptor activity, altogether evoking dryness sensations and pain.
The Diagnostic Methodology and Management and Therapy subcommittees produced what I think should be easy to use and valuable schematics to take you through their recommendations – one of these is reproduced here:
“Dry Eye Disease diagnostic test battery” reprinted from The Ocular Surface Vol 15 2017. Wolffsohn JS et al. TFOS DEWS II Diagnostic Methodology report, with permission from Elsevier.
Missed our Alumni Evening? You can catch up on all the TFOS DEWSII Dry Eye themed lectures here: