TFOS DEWS II Diagnostic Methodology report.
Ocul Surf 2017 Jul; 15(3):539-574.OS

Abstract

The role of the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II Diagnostic Methodology Subcommittee was 1) to identify tests used to diagnose and monitor dry eye disease (DED), 2) to identify those most appropriate to fulfil the definition of DED and its sub-classifications, 3) to propose the most appropriate order and technique to conduct these tests in a clinical setting, and 4) to provide a differential diagnosis for DED and distinguish conditions where DED is a comorbidity. Prior to diagnosis, it is important to exclude conditions that can mimic DED with the aid of triaging questions. Symptom screening with the DEQ-5 or OSDI confirms that a patient might have DED and triggers the conduct of diagnostic tests of (ideally non-invasive) breakup time, osmolarity and ocular surface staining with fluorescein and lissamine green (observing the cornea, conjunctiva and eyelid margin). Meibomian gland dysfunction, lipid thickness/dynamics and tear volume assessment and their severity allow sub-classification of DED (as predominantly evaporative or aqueous deficient) which informs the management of DED. Videos of these diagnostic and sub-classification techniques are available on the TFOS website. It is envisaged that the identification of the key tests to diagnose and monitor DED and its sub-classifications will inform future epidemiological studies and management clinical trials, improving comparability, and enabling identification of the sub-classification of DED in which different management strategies are most efficacious.

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Authors+Show Affiliations

Wolffsohn JSOphthalmic Research Group, Aston University, Birmingham, UK. Electronic address: j.s.w.wolffsohn@aston.ac.uk.

Arita RDepartment of Ophthalmology, Itoh Clinic, Saitama, Japan.

Chalmers RClinical Trial Consultant, Atlanta, GA, USA.

Djalilian AIllinois Eye and Ear Infirmary, UIC Department of Ophthalmology & Visual Sciences, Chicago, IL, USA.

Dogru MDepartment of Opthalmology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan.

Dumbleton KSchool of Optometry, University of California, Berkeley, CA, USA.

Gupta PKCornea & Refractive Surgery, Duke Eye Center, Durham, NC, USA.

Karpecki PKentucky Eye Institute & University of Pikeville, KY, USA.

Lazreg SCabinet Ophtalmologie, Alger Centre, Algiers, Algeria.

Pult HOphthalmic Research Group, Aston University, Birmingham, UK; 'Dr Heiko Pult - Optometry and Vision Research', Weinheim, Germany; School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.

Sullivan BDTearlab, San Diego, CA, USA.

Tomlinson ADepartment of Vision Sciences, Glasgow Caledonian University, Glasgow, UK.

Tong LCorneal and External Eye Disease, Singapore National Eye Center, Singapore.

Villani EDepartment of Clinical Sciences and Community Health, University of Milan & Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy.

Yoon KCDepartment of Ophthalmology, Chonnam National University Hospital, Gwangju, South Korea.

Jones LCentre for Contact Lens Research, University of Waterloo, Waterloo, Ontario, Canada.

Craig JPNew Zealand National Eye Centre, Department of Ophthalmology, The University of Auckland, Auckland, New Zealand.