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Ocul Surf. 2017 Jul;15(3):575-628. doi: 10.1016/j.jtos.2017.05.006. Epub 2017 Jul 20.

TFOS DEWS II Management and Therapy Report.

Author information

1
Centre for Contact Lens Research, School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada. Electronic address: lwjones@uwaterloo.ca.
2
Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia.
3
Korb & Associates, Boston, MA, USA.
4
Department of Ophthalmology, University of Complutense, Madrid, Spain.
5
Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
6
Stein Eye Institute, UCLA, Los Angeles, CA, USA.
7
Department of Corneal and External Disease, Vietnam National Institute of Ophthalmology, Hanoi, Viet Nam.
8
Department of Ophthalmology, University Hospital Duesseldorf, Germany.
9
Department of Ophthalmology, Santa Casa de Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil.
10
Schepens Eye Research Institute, Massachusetts Eye & Ear, Boston, MA, USA.
11
Department of Ophthalmology, Yonsei University Medical College, Seoul, South Korea.
12
Tauber Eye Center, Kansas City, MO, USA.
13
Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo, São Paulo, Brazil.
14
Department of Ophthalmology and Visual Science, Eye, and ENT Hospital, Shanghai Medical College, Fudan University, China.
15
Ophthalmic Research Group, Aston University, Birmingham, UK.
16
Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.

Abstract

The members of the Management and Therapy Subcommittee undertook an evidence-based review of current dry eye therapies and management options. Management options reviewed in detail included treatments for tear insufficiency and lid abnormalities, as well as anti-inflammatory medications, surgical approaches, dietary modifications, environmental considerations and complementary therapies. Following this extensive review it became clear that many of the treatments available for the management of dry eye disease lack the necessary Level 1 evidence to support their recommendation, often due to a lack of appropriate masking, randomization or controls and in some cases due to issues with selection bias or inadequate sample size. Reflecting on all available evidence, a staged management algorithm was derived that presents a step-wise approach to implementing the various management and therapeutic options according to disease severity. While this exercise indicated that differentiating between aqueous-deficient and evaporative dry eye disease was critical in selecting the most appropriate management strategy, it also highlighted challenges, based on the limited evidence currently available, in predicting relative benefits of specific management options, in managing the two dry eye disease subtypes. Further evidence is required to support the introduction, and continued use, of many of the treatment options currently available to manage dry eye disease, as well as to inform appropriate treatment starting points and understand treatment specificity in relation to dry eye disease subtype.

KEYWORDS:

Dry eye disease; Dry eye workshop; Management; TFOS DEWS II; Therapy

PMID:
28736343
DOI:
10.1016/j.jtos.2017.05.006
[Indexed for MEDLINE]

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