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TFOS DEWS II: What it is, and why it's here on the forum

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  • TFOS DEWS II: What it is, and why it's here on the forum

    What is TFOS DEWS II?
    For those of you who are hearing of TFOS DEWS II for the first time, it is, quite simply, the dry eye bible when it comes to the medical side of understanding, diagnosing and treating dry eye.

    This massive report, published in summer of 2017, is the result of a 2 1/2 year project involving 150 professionals from around the world. As the sequel to the original TFOS DEWS report published in 2007, which helped spur a great many changes in the understanding and treatment of dry eye disease, the new report represents a complete update of the original (reviewing the last 10 years years of developments, particularly in peer reviewed literature), but it also contains brand new reports on topics not covered in the same way originally. Two of those that are particularly exciting are Iatrogenic Dry Eye, and Pain and Sensation.

    Here is a brief outline of all the reports comprising TFOS DEWS II:
    • Introduction: Puts the whole report in context. Explains why the whole thing is so long! Lists all subcommittee members. Summarizes findings of each report in a couple of compact little paragraphs. Great read.
    • Definition and Classification: Amongother things, presents the much-debated definition of dry eye in all its glory, and explains why defining this disease is so intensely controversial.
    • Sex, Gender and Hormone: Dry eye affects women more than men, and this report explores the reasons why.
    • Epidemiology: What we know today about how many people get dry eye and what the risk factors are, plus examines the dry eye symptom questionnaires.
    • Tear Film: Explores in great depth the extraordinary fluid called tears.
    • Pain and Sensation: Exciting much-awaited new topic!
    • Pathophysiology: The "how" of dry eye.
    • Iatrogenic Dry Eye: The many drugs, surgeries, procedures and medical devices that can cause or worsen dry eye.
    • Diagnostic Methodology: Covers all the different types of tests and proposes how to approach dry eye diagnsosis.
    • Management and Therapy: Everyone's favorite. This is the exhaustive source of all of the medical side of treating dry eye, and some of the practical side is touched on as well.
    • Clinical Trial Design: Discusses, among other things, some of the frustrating reasons why no dry eye drugs got approved for so many years, even though we know some work.
    Why make so much space for something so technical on DRYEYEZONE's forums?

    I've had the privilege of serving on TFOS DEWS II"s public awareness and education subcommittee. But I'm not posting it specifically on their behalf - it just plays naturally into so many other things I care about.

    1. It's so incredibly convenient as a reference.

    This one document basically summarizes everything science knows today about dry eye and as such is the perfect go-to when we want to look things up. Instead of hunting down individual studies, we can hunt down a topic in a subreport and reference that. (All references supporting the reports themselves are listed at the end of each.)

    2. Patients need reliable sources for information they bring to their doctors.

    The need to advocate for ourselves, seek out less known treatments and, sometimes, to educate our eye doctors - these are facts of life for many dry eye patients, especially those with severe, chronic conditions. And while most doctors these days understand that many patients will do their own research online and that they have to be willing to discuss these things with us, they will also push back when they feel the information we bring them is from the infamous Dr Google or just anecdotes from other patients.

    The TFOS DEWS II report, I believe, will make it easier for us patients to take the extra step of looking up the things we want to bring to our doctors, for example, a diagnostic method or a treatment. We can then bring a well documented, well referenced source of information, without the bewildering burden of figuring out what is reliable amongst so many sources.

    3. We need a place to highlight the best and most important parts!

    ...The stuff that patients need to know, the stuff that patients need doctors to know!

    These reports are incredible treasure troves of information. Some of it flatly contradicts conventional dry eye diagnosis and treatment wisdom. Some of it covers areas no one has even started talking about yet. Some of it points out facts that could help PREVENT a lot of dry eye. And on, and on, and on. There is just so much value lurking between those pages.

    But... they are medical reports, and some of them are so technical and so highly specialized that relatively few eye doctors, let alone patients, will ever pageturn them . How do we extract the most timely, most relevant information, and how do we get it in front of those who could most benefit? This is the "education" challenge for TFOS DEWS II. I know I will be reading and regurgitating information from these reports for a long time to come, but I know there are also a great many patients who are at least as well equipped as me to be part of that process. I've been highlighting facts on Twitter and I'll be posting extracts with comments here too. I hope I can encourage some of you to pile in and do the same.

    4. We need a place for discussion with eye doctors.

    There's a lot to wrestle with. Why are so many glaucoma patients still using BAK-preserved drops without any warning from their glaucoma doctor about the dry eye risks, and what can/should they do? Why don't all eye doctors routinely assess their patients' dry eye symptoms using a scientifically validated survey instrument, how does this failure hurt us patients, and what can we all do about it? And endless more. I want to foster dialogue about these things!

    -------------
    We have so many gaps in dry eye disease that need bridging:

    The GAP between what the science and research communities know, and what our eye doctors know.
    The GAP between what we patients care about, and what our doctors think we care about.
    The GAP between what improves our tear film, and what makes us feel better.
    The GAP between what the FDA requires on our behalf, and what we would want them to require if it were up to us.

    The more dialogue about it all, the better!
    Rebecca Petris
    The Dry Eye Zone

  • #2
    Are hard copies of this available for purchase, I find it difficult to comb through realms of paper online besides I like to underline and highlight as I go for future reference.

    Comment


    • #3
      There are PDFs available at the links that can be printed out. I will find out about the hard copies!
      Rebecca Petris
      The Dry Eye Zone

      Comment


      • #4
        farmgirl No hard copies at this time - they're waiting on fundraising. The PDFs print up great... I'm contemplating a second run for myself of the ones that have gotten a bit too dog-eared.
        Rebecca Petris
        The Dry Eye Zone

        Comment


        • #5
          Thanks Rebecca

          Comment


          • #6
            That is awesome. It's good to know there are doctors sharing important information about dry eye. Half the battle is getting clinical doctors educated.
            What you need to know about computer-induced dry eye
            Dry Eye Survey
            IPL Doctors
            Probing Doctors
            PRP Injections Warning

            Comment


            • #7
              Originally posted by pythonidler View Post
              Half the battle is getting clinical doctors educated.
              Ain't that the truth.
              Rebecca Petris
              The Dry Eye Zone

              Comment


              • #8
                Originally posted by Rebecca Petris View Post
                What is TFOS DEWS II?
                -------------
                We have so many gaps in dry eye disease that need bridging:

                The GAP between what the science and research communities know, and what our eye doctors know.
                The GAP between what we patients care about, and what our doctors think we care about.
                The GAP between what improves our tear film, and what makes us feel better.
                The GAP between what the FDA requires on our behalf, and what we would want them to require if it were up to us.

                The more dialogue about it all, the better!
                Thank you for taking the time to find and explain what TFOS DEWS II is and for laying out the gaps, which is where so much pain and suffering stems from!
                Limbal staining w/ slight MGD and low tBUT

                Comment


                • #9
                  Yes, thanks so much Rebecca for the above outline and explanations, it helps make this huge report more approachable for the average patient!

                  It will be a challenge to get all our doctors to really read and apply all this, but at least this update is out there now for them and us to reference, and to improve treatment and understanding.

                  Comment


                  • #10
                    I'm not sure why I overlooked this until now. I feel like this will cut down the amount of searching and trawling through disparate sources I end up doing, and become my default place to start when researching a topic.

                    Comment

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