The aim of the DEWS Definition and Classification Subcommittee was to provide a contemporary definition of dry eye disease, supported within a comprehensive classification framework. A new definition of dry eye was developed to reflect current understanding of the disease, and the committee recommended a three-part classification system. The first part is etiopathogenic and illustrates the multiple causes of dry eye. The second is mechanistic and shows how each cause of dry eye may act through a common pathway. It is stressed that any form of dry eye can interact with and exacerbate other forms of dry eye, as part of a vicious circle. Finally, a scheme is presented, based on the severity of the dry eye disease, which is expected to provide a rational basis for therapy. These guidelines are not intended to override the clinical assessment and judgment of an expert clinician in individual cases, but they should prove helpful in the conduct of clinical practice and research.

The definition and classification of dry eye disease: Report of the definition and classification subcommittee of the international Dry Eye WorkShop (2007)

The subcommittee reviewed the prevalence, incidence, risk factors, natural history, morbidity and questionnaires reported in epidemiological studies of dry eye disease (DED). A meta-analysis of published prevalence data estimated the impact of age and sex. Global mapping of prevalence was undertaken. The prevalence of DED ranged from 5 to 50%. The prevalence of signs was higher and more variable than symptoms. There were limited prevalence studies in youth and in populations south of the equator. The meta-analysis confirmed that prevalence increases with age, however signs showed a greater increase per decade than symptoms. Women have a higher prevalence of DED than men, although differences become significant only with age. Risk factors were categorized as modifiable/non-modifiable, and as consistent, probable or inconclusive. Asian ethnicity was a mostly consistent risk factor. The economic burden and impact of DED on vision, quality of life, work productivity, psychological and physical impact of pain, are considerable, particularly costs due to reduced work productivity. Questionnaires used to evaluate DED vary in their utility. Future research should establish the prevalence of disease of varying severity, the incidence in different populations and potential risk factors such as youth and digital device usage. Geospatial mapping might elucidate the impact of climate, environment and socioeconomic factors. Given the limited study of the natural history of treated and untreated DED, this remains an important area for future research.

TFOS DEWS II Epidemiology Report.

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.

TFOS DEWS II Diagnostic Methodology report

Human corneal thickness and its impact on intraocular pressure measures: a review and meta-analysis approach.

Objective To examine risk factors for the prevalence of dry eye syndrome in a population-based cohort. Methods The prevalence of dry eye was determined by history at the second examination (1993-1995) of the Beaver Dam Eye Study cohort (N = 3722). Results The cohort was aged 48 to 91 years (mean ± SD, 65 ± 10 years) and 43% male. The overall prevalence of dry eye was 14.4%. Prevalence varied from 8.4% in subjects younger than 60 years to 19.0% in those older than 80 years ( P P Conclusion The results suggest several factors, such as smoking, caffeine use, and multivitamin use, could be studied for preventive or therapeutic efficacy.

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/413594/eeb90020.pdf

Prevalence of and Risk Factors for Dry Eye Syndrome

Purpose The purpose of this study was to determine the impact of extended wear of high and low oxygen permeability (Dk) lenses on the development or resolution of limbal hyperemia and corneal neovascularization in a randomized prospective clinical trial Methods Adapted daily-wear contact lens wearers were randomly assigned to one of two groups The low-Dk group (N = 23) wore etafilcon A lenses (Dk/t = 40) for up to 7 days and 6 nights, and the high-Dk group (N = 39) wore lotrafilcon A lenses (Dk/t = 175) for up to 30 days and nights Limbal hyperemia and neovascularization were assessed and graded during 9 months of extended wear A stratified analysis to determine how change in ocular redness depended on initial presentation was also conducted Results On a 0 to 100 scale, extended wear of low-Dk lenses resulted in a 16-point increase in limbal hyperemia (p < 00001); no significant change occurred with the high-Dk lenses The difference was greatest for low-Dk participants who initially presented with lower levels of hyperemia (N = 18) There was a slight resolution of redness in participants who initially presented with higher levels of hyperemia (N = 10) after wearing the high-Dk lenses Neovascularization increased by an average of 05 on a scale of 0 to 4 in low-Dk lens wearers (p < 00001) but remained unchanged in the high-Dk lens wearers The increase was most marked for the low-Dk group with lower levels of neovascularization at baseline Conclusions Subjects who wore lenses with higher oxygen permeability for 9 months of extended wear exhibited a lower vascular response of the ocular surface compared with subjects who wore lenses of lower oxygen permeability for the same period This result was found both for the surface limbal vessels and in the deeper neovascular stromal vessels Moderate neovascularization also developed after 3 months of extended wear of low-Dk hydrogels, whereas high-Dk lenses caused no neovascularization

Vascular response to extended wear of hydrogel lenses with high and low oxygen permeability.

CANDEES. The Canadian Dry Eye Epidemiology Study.

Purpose: A four-month extended wear clinical trial was conducted to compare the ocular effects of a high Dk Balafilcon A silicone hydrogel lens and a low Dk HEMA 38.6 per cent H20 soft lens. Method: Twenty-four subjects who were adapted to daily wear of soft lenses wore a high Dk lens in one eye and a low Dk HEMA lens in the other eye for four months on an extended wear basis after one week of daily wear. Thirteen progress evaluations were conducted using standard clinical procedures. Results: Eighteen subjects (75 per cent) completed the study. The high Dk lens induced significantly less bulbar and limbal injection and corneal vascularisation than the low Dk HEMA lens (p < 0.05). Epithelial microcysts were observed only in the eyes wearing the low Dk lens. A significant increase in myopia was found in the eyes wearing the low Dk HEMA lens (mean = 0.50 D, p < 0.01) compared to the insignificant myopic increase of 0.06 D in the eyes wearing the high Dk lens. Three subjects developed small infiltrates in the high Dk lens wearing eyes and significantly more post-lens debris was observed under the high Dk lens. Six subjects developed papillary conjunctivitis in the eye wearing silicone hydrogel lenses but only two of those were discontinued from the study. Conclusion: No hypoxia-related effects were observed with extended wear of the high Dk Balafilcon A silicone hydrogel lens.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1444-0938.2002.tb03032.x

The ocular response to extended wear of a high Dk silicone hydrogel contact lens.

:Background: A small but significant increase in myopia after extended wear of low oxygen permeability (Dk) hydrogel lenses has been previously reported; however, the specific impact of hypoxia on refractive status and corneal curvature with extended wear are not well documented. The purpose

Changes in myopic refractive error with nine months' extended wear of hydrogel lenses with high and low oxygen permeability.

Relationship between compliance with lens replacement and contact lens-related problems in silicone hydrogel wearers

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