The TFOS DEWS II diagnostic algorithm is regarded as a comprehensive tool for diagnosing dry eye disease (DED), but – when lacking in resources or under the strain of working in the fast-paced environs of a successful practice, for example – clinicians can often fall short of applying this set of guidelines to its full potential.
To clarify the TFOS DEWS II guidelines, as well as evaluate the diagnostic sensitivity of each of the homeostatic signs detailed by the algorithm, a new paper in The Ocular Surface has examined data sets from 1,427 patients across the UK, Australia, Canada, and New Zealand.
The data comprised the full set of tests indicated for use by TFOS DEWS II, including Ocular Surface Disease Index (OSDI) questionnaire results, ocular surface staining, tear osmolarity, and on-invasive break-up time (NIBUT), with tests evaluating tear film homeostasis – as well as varying combinations of the aforementioned signs – being either included or excluded from the final results to allow for comparisons to be made.
TFOS DEWS II currently recommends that an ocular surface evaluation is performed on a patient, including ocular surface staining (i.e., staining of the cornea, lid margin, and conjunctiva). The paper notes that this comprehensive method – combined with symptomatic assessment using either the five-item Dry Eye Questionnaire (DEQ-5) or the Ocular Surface Disease Index (OSDI) – yielded the highest diagnostic sensitivity at 87.7 percent. Meanwhile, the diagnostic sensitivity dropped to only 44.6 percent when corneal staining alone was evaluated, and, if clinicians excluded either tear osmolarity or non-invasive tear breakup time from their tests, sensitivity would drop by around five percent each time, the authors state.
The multi-institutional team concludes that the “TFOS DEWS II diagnostic algorithm of symptoms plus assessing for a tear film (non-invasive tear breakup time or tear osmolarity) and ocular surface sign can be considered a robust and appropriate approach for DED diagnosis.”
James Wolffsohn, study co-author and head of the School of Optometry and the Department of Audiology at Aston University, Birmingham, UK, observes: “It is essential that all practitioners around the world adopt the same, simple diagnostic algorithm.” He continues, “Patients need certainty on their diagnosis, and consistent epidemiological data is required to inform allocation of healthcare resources.” However, he adds, practitioners can use other questionnaires and clinical tests to inform sub-typing of the disease and its management and therapy.
Sponsored by Alcon and Bausch + Lomb, the TFOS DEWS III report – an update on the current guidelines provided by TFOS DEWS II – is due to be published by the Tear Film & Ocular Surface Society later this year.
