Defining Dry Eye from a Clinical Perspective.

Kazuo Tsubota,Christophe Baudouin,Hyo Myung Kim,Reza Dana,Norihiko Yokoi,Zuguo Liu,Elisabeth M Messmer,Jimena Tatiana Carreno-Galeano,Maurizio Rolando,Shigeru Kinoshita,Friedrich Kruse,Lingyi Liang,Stephen C Pflugfelder

doi:10.3390/ijms21239271

Abstract

Over the past decades, the number of patients with dry eye disease (DED) has increased dramatically. The incidence of DED is higher in Asia than in Europe and North America, suggesting the involvement of cultural or racial factors in DED etiology. Although many definitions of DED have been used, discrepancies exist between the various definitions of dry eye disease (DED) used across the globe. This article presents a clinical consensus on the definition of DED, as formulated in four meetings with global DED experts. The proposed new definition is as follows: “Dry eye is a multifactorial disease characterized by a persistently unstable and/or deficient tear film (TF) causing discomfort and/or visual impairment, accompanied by variable degrees of ocular surface epitheliopathy, inflammation and neurosensory abnormalities.” The key criteria for the diagnosis of DED are unstable TF, inflammation, ocular discomfort and visual impairment. This definition also recommends the assessment of ocular surface epitheliopathy and neurosensory abnormalities in each patient with suspected DED. It is easily applicable in clinical practice and should help practitioners diagnose DED consistently. This consensus definition of DED should also help to guide research and clinical trials that, to date, have been hampered by the lack of an established surrogate endpoint.

Highlights

Introduction and Existing Definitions of DryEye Disease (DED)Dry eye disease (DED) is a common ocular disorder affecting tens of millions of people; its incidence and prevalence in Asia is higher than in Europe and North America, suggesting that cultural or racial factors are involved in dry eye disease (DED) etiology [1,2,3,4,5,6].The common perception of DED is one of a simple disease, primarily caused by decreased tear production—such as the aqueous tear deficiency (ATD) type of dry eye seen in Sjögren’s syndrome
Clinicians need to be cautious in order to not miss visual impairment due to DED, while ocular surface epitheliopathy, inflammation and neurosensory abnormalities should be assessed in each patient
The increase in visual tasks, an aging society, sleep deprivation, impairments in circadian rhythms, lack of exercise, increase in obesity and sedentary lifestyles could contribute to the increase in DED incidence [157,158,159,160,161]

Summary

Introduction

Introduction and Existing Definitions of DryEye Disease (DED)Dry eye disease (DED) is a common ocular disorder affecting tens of millions of people; its incidence and prevalence in Asia is higher than in Europe and North America, suggesting that cultural or racial factors are involved in DED etiology [1,2,3,4,5,6].The common perception of DED is one of a simple disease, primarily caused by decreased tear production—such as the aqueous tear deficiency (ATD) type of dry eye seen in Sjögren’s syndrome. Dry eye disease (DED) is a common ocular disorder affecting tens of millions of people; its incidence and prevalence in Asia is higher than in Europe and North America, suggesting that cultural or racial factors are involved in DED etiology [1,2,3,4,5,6]. The common perception of DED is one of a simple disease, primarily caused by decreased tear production—such as the aqueous tear deficiency (ATD) type of dry eye seen in Sjögren’s syndrome. DED owing to decreased tear production and DED resulting from tear instability alone share some features but could exist independently. The different clinical presentations of DED has led to some misunderstandings of the condition and the need for a consensus on a clinical definition. Various organizations have proposed different definitions and diagnostic criteria for DED

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Conclusion