Reviews Supplements Dry Eye Disease 2016 : Page 2

2 dry eye disease INTRODUCTION Although critically important to the practice of optometry, a sophisticated understanding of dry eye disease (DED) is a relatively recent development. Just 20 years ago, DED was a poorly understood entity for which there was a significant controversy with respect to diagnosis. 1 This picture began to change with the publication of the “Report of the National Eye Institute/Industry Workshop on Clinical Trials in Dry Eyes.” 1 Like the subsequent DEWS Report, the NEI/Industry Workshop brought together and gave structure to our then-current knowledge of DED and laid the groundwork for future research and understanding. Thanks to significant interest—including commercial interest—the field has grown rapidly. So much has happened that a second DEWS Report (DEWS II) is now being undertaken. Arthur B. Epstein, OD, FAAO, FABCO, FBCLA, DPNAP, is co-founder of Phoenix Eye Care, PLLC, where he heads the Ocular Surface Disease Center and serves as the Center’s director of clinical research. Paul M. Karpecki, OD, FAAO, heads the Advanced Ocular Surface Disease Center and is director of clinical research at the Koffler Vision Group, Lexington, KY. Katherine M. Mastrota, MS, OD, FAAO, is Regional Practice Ambassador/ Director, Omni Eye Surgery New York Dry Eye/Ocular Wellness Center. Walter O. Whitley, OD, is Director, Optometric Services at Virginia Eye Consultants, Norfolk, VA. TOWARDS A NEW UNDERSTANDING So how far have we come? And what does a new understanding mean for optometric practice? We can start by looking back. In 1995, the NEI/Industry Workshop defined dry eye as “a disorder of the tear film due to tear deficiency or excessive evaporation, which causes damage to the interpalpebral ocular surface and is associated with symptoms of ocular discomfort.” 1 This definition recognized two primary etiologies (aqueous deficiency and excessive evaporation), a sign (ocular surface “damage,” primarily detectable by staining [Figure 1]), and a symptom (discomfort) but was otherwise silent with respect to causes, effects, or corollaries of the condition. 1 Twelve years after the NEI/ Industry Workshop, the DEWS Report was able to offer a more robust definition: Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface. 2 FIGURE 1 Fluorescein stain shows inferior corneal staining suggestive of DED tissue damage. ( Photo courtesy Dr. Karpecki.)

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