What's in a name? Your votes please!

[Rebecca Petris]

There is an ongoing debate in ophthalmology about whether or not the term "dry eye" should continue to be used to refer to the complex disease(s) collectively known under this name at present.

Some of you no doubt remember when about a year and a half ago the term "Dysfunctional Tear Syndrome" (DTS) was proposed by a Delphi panel. They argued, among other things, that:

- Not all dry eye patients actually have dry eyes, as opposed to lid margin disease, unstable tear film, etc.
- Continuing to use the term "dry eye" could "misdirect clinicians into thinking erroneously about its underlying cause, techniques for diagnosis, and proper treatment."
- The term DTS could help doctors and patients communicate better.

A group of doctors who prefer the term "dry eye" set forth their rationale in favor of keeping the status quo in an editorial in the latest issue of Cornea (well, technically September issue, but the hard copy just came out now). They counter-argue as follows:

- The term "dry eye" is well recognized by both the profession and the public;
- It's clinically valid, equivalent to predecessor "KCS";
- Even if it's a misnomer in some sense, well, so is the word "stroke" which refers to three different types of events; and
- Donations to dry eye research would probably drop because of confusion if the term "dry eye" were no longer used;
- Trying to be precise is a good idea but not if it comes at the cost of confusing people.

Fine, the doctors have had their say. I would be interested to see what patients think our disease should be called and why. Please vote and post comments about why you think any of these names is good, bad, or indifferent.

[neil0502]

I picked OSD. Here's why:

First, I think accuracy is always best. When you even look at the difference between aqueous deficient and evaporative, you see that it's tough for the specific labels to really work. Some people have Schirmer's of 20mm--they're SWIMMING in tears. Hard to call those eyes dry ... especially when people SEE them running from your cauterized peepers.

Of course, we all know they might evaporate in one second, causing pain, blurring, etc.

OSD fits both of those, AND corneal hyperesthesia, AND goblet cell density issues, etc.. The "Sicca" in KCS MEANS dryness, too. I might tend to exclude THAT one for the same reason, though it is a mouthful ... which isn't necessarily a bad thing. See #2.

Second, it should sound ominous. It should sound a little like we're suffering, sick, or dying. It should evoke just a slight sense of "Really? Wow. I'm so sorry" from people because--as we all know--you say "I have dry eyes" and people think, "Have you tried using eyedrops??" It should be a weighty enough word that people simply take IT and US seriously.

OCULAR SURFACE DISEASE has the necessary weight and ugly factor to it, IMHO.

Other thoughts??

[indrep]

I originally voted for OSD. After thinking about it Ocular Surface disease could be any number of issues. As far as Dry Eye goes the ocular surface disease state doesn't come untill after the Dry Eye process has started.

I vote for Dry Eye Syndrome.

[cristinalatina]

I chose Ocular surface disease for the same reasons that Neil did. I agree that "dry eye" indicates a condition that might be both temporary and chronic, mild and severe. I think that the term "disease" is more accurate and sounds less common than simply "dry eye".

[Niteyorkie]

I like OSD too. When I say I have dry eyes, most people say "yeah I do too". Knowing they have no idea what really dry eyes are. Especially when they say they use Visine.

[dianat]

OSD. I'm tired of explaining and re-explaining why I have an overflow of tears. I like to think my circle of acquaintances is intelligent, but I swear I haven't gotten through to them regarding my eye condition. Nobody listens to me long enough to understand my condition exactly.

I do like the idea of having a term that isn't too descriptive...a little mysterious even. And OCD does the trick very nicely. Yes, I do like it. It even encompasses the tear composition issue as well as the tear quantity problem.

How fun! I feel like I'm back in marketing brainstorming ideas on naming a new product!

Oh yeah, and it also brings to mind a condition our pediatrician years ago used to describe my infant son's illness: post-tussis emesis. My husband and I laughed out loud at the diagnosis because we knew that emesis was a medical term for vomit and tussis a term for cough. We were already well-aware that Alex was vomiting due to a cough. If we hadn't understood the fancy definition, we might've taken him straight to the ER.

Sorry to digress.

[neil0502]

When you called it "OCD" in the second paragraph ... was that a Freudian slip?

[dianat]

OSD, OCD...whatever it takes.

Yes, I just might show signs of OCD. I log onto this web site about 20 times a day. Hey, and I blot my blasted eyes about 100 times a day. That's OC. Yeah, I'd definitely say it was a Freudian slip. Thanks for noticing!

D

[kitty]

I chose KCS because it sounds horrible, and it is! It is also the diagnosis that my Dr. gave me. I do not feel that DES acurately describes the complexity of the disorder and the resultant alterations in lifestyle. To me, it's like calling Multiple Sclerosis "damaged nerve syndrome". Both refer to the same thing, but the clinical name seems to give it more credibility as being a legitimate disorder.

[YGB]

I prefer ocular surface disease (OSD) or if there is a need for more specificity then it can be OSD caused by dry eye. Kitty, your comparison to multiple sclerosis (MS) is interesting because I was just told the other day that I should be able to manage at work just fine since you have folks with MS who figure out a way to work. I am certainly not looking to minimize MS or cancer or any other debilitating disease because I am sure they are all terrible to have. It's just unfortunate that we end up with a potentially debilitating condition and people really do not understand the severity of it. Part of the reason is definitely the term "dry eye". Dry eye syndrome definitely does not do the condition justice and for dry eye sufferers to ever get any true understanding from the public, there is a need for a new name for the condition.

[neil0502]

FWIW (not much), the word "debilitating" does appear rather frequently in the literature in the context of Dry Eye Syndrome [1]. Aside from providing a certain amount of validation that, probably, most of us benefit from hearing once in a while, for some of us, there may be practical, economic, administrative, or legal implications to having this recognized by the medical community.

In other words, while we may (rightfully) discuss whether the term "dry eyes" really conveys the depth of what we experience, the medical community does seem to have caught on.

[1] http://scholar.google.com/scholar?q=...avclient&hl=en

[YGB]

Neil - I assume the medical community you are primarily referring to that has "caught on" about the potentially debilitating effects of dry eye are ophthalmologists. If this were truly the case, these MD's would not allow refractive surgery such as LASIK to be done. From an ethical standpoint, no MD who has "caught on" should perform an elective procedure with a good chance of creating dry eye symptoms (in addition other debilitating complications) and then later tell the patient ... "sorry but there were no guarantees".

Patients are not being truly informed of the dangers of LASIK. If they were, then there would be a whole lot less LASIK cases being done. I've been to 5 MD's so far since I developed my dry eye condition, and I can say that only 1 has "caught on" although even he has his moments when I wonder. Note that the 3 LASIK MD's that I have seen have definitely not caught on and they are either in a state of denial or a lot more cold hearted than I ever imagined an MD would be.

[dianat]

Rebecca,

If the community of eye professionals decide that say Ocular Surface Disease is a better name for our condition, will you then call the web site "Ocular Surface Disease Zone"?!

[Flick]

Not sure about our official name, but I do have a vote for our official pet: The Cavalier King Charles Spaniel. These cute little guys apparently have a high rate of dry eye/OSD/KCS.

http://www.cavalierhealth.org/dry_eye.htm

It's frustrating enough putting drops in all day, but imagine not being able to do it yourself. Arghh. Interesting also that in severe cases some doggies have their salivary gland moved up near the eye so that the eye gets saliva.

[Guest]

OSD Zone?

Rebecca,

If the community of eye professionals decide that say Ocular Surface Disease is a better name for our condition, will you then call the web site "Ocular Surface Disease Zone"?!

Heh. I've wondered about this myself. The thought of designing a logo for such a name is giving me a nervous twitch.