TFOS DEWS II Diagnostic Methodology report

TitleTFOS DEWS II Diagnostic Methodology report
Publication TypeJournal Article
Year of Publication2017
AuthorsWolffsohn, J. S., R. Arita, R. Chalmers, A. Djalilian, M. Dogru, K. Dumbleton, P. K. Gupta, P. Karpecki, S. Lazreg, H. Pult, B. D. Sullivan, A. Tomlinson, L. Tong, E. Villani, K. C. Yoon, L. Jones, and J. P. Craig
JournalOcular Surface
Keywordsallergic conjunctivitis, asthenopia, atopic keratoconjunctivitis, bacterial conjunctivitis, biological marker, blepharitis, blinking, chemokine, clinical protocol, comorbidity, Computer vision symptom scale, confocal microscopy, Conjunctiva, conjunctiva disease, cornea disease, cytokine, Demodex, demodicosis, DEWS, Diagnosis, diagnostic methodology subcommittee, diagnostic test, differential diagnosis, disease classification, disease course, Dry eye, Dry eye disease (DED), Dry eye questionnaire, Dry Eye Related Quality of Life Score, Dry Eye Syndromes, Dry eye workshop, eye disease assessment, eye inflammation, eye redness, eyelid disease, filamentary keratitis, Fluorescein, fluorescein breakup time, functional status assessment, giant papillary conjunctivitis, graft versus host reaction, human, Humans, impression cytology, in vivo confocal microscopy, interferometry, keratoconjunctivitis sicca, keratopathy, lacrimal fluid, lid parallel conjunctival fold, lid sensitivity, lid wiper epitheliopathy, light scattering, lissamine green staining, matrix metalloproteinase, medical society, medical technology, medical terminology, Meibography, meibomian gland, meniscometry, methodology, minimal clinically important difference, monitoring, motivation, National Eye Institute Visual Function Questionnaire, non invasive tear breakup time, Ocular surface disease, Ocular Surface Disease Index, ocular surface sensitivity, Osmolar Concentration, Osmolarity, parasitic eye infection, patient monitoring, phenol red thread test, practice guideline, professional standard, psychological aspect, quality of life assessment, questionnaire, Questionnaires, Review, rheumatic disease, risk factor, sampling, Schirmer test, selection bias, spectrum bias, staining, statistical bias, Sub-classification of dry eye, symptom, tear evaporation rate, tear film, tear film ferning, tear osmolarity, Tears, Tests for dry eye, thermography, validation process, vernal conjunctivitis, viral conjunctivitis, visual disorder, visual system examination, visual system parameters, workshop
AbstractThe 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. © 2017 Elsevier Inc.