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Eye Contact Lens. 2019 Aug 13. doi: 10.1097/ICL.0000000000000643. [Epub ahead of print]

A New Perspective on Dry Eye Classification: Proposal by the Asia Dry Eye Society.

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Department of Ophthalmology (K.T., M.D., T.K.), Keio University School of Medicine, Tokyo, Japan; Department of Ophthalmology (N.Y., S.K.), Kyoto Prefectural University of Medicine, Kyoto, Japan; Eye Division (H.W.), Kansai Rosai Hospital, Amagasaki, Japan; Japanese Red Cross Gifu Hospital (T.K.), Gifu, Japan; Eye Center (M.Y.), Kyorin University School of Medicine, Tokyo, Japan; Department of Ophthalmology (H.-M.K.), Korea University Anam Hospital, Seoul, Korea; Department of Ophthalmology (H.-W.T.), Ulsan University Asan Medical Center, Seoul, Korea; Department of Ophthalmology (J.Y.H.), Seoul National University, Seoul National University Bundang Hospital, Seoul, Korea; Department of Ophthalmology (K.C.Y.), Chonnam National University Hospital, Gwangju, Korea; Department of Ophthalmology (K.Y.S.), Yonsei University Severance Hospital, Seoul, Korea; Department of Ophthalmology (X.S.), Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing, China; Cornea Service (W.C.), The Affiliated Eye Hospital of Wenzhou Medical University, Menzhou, China; Zhongshan Ophthalmic Center Sun Yat-Sen University (L.L.), Guangzhou, China; Department of Ophthalmology (M.L.), Peking University International Hospital, Beijing, China; Singapore National Eye Center (L.T.), Singapore; Department of Ophthalmology (F.-R.H.), National Taiwan University Hospital, Taipei, Taiwan; Department of Ophthalmology (V.P.), Chulalongkorn University (V.P.), Bangkok, Thailand; Department of Ophthalmology (R.L.-B.-S.), University of the Philippines, Manila, Philippines; International Specialist Eye Centre/National University Hospital (T.K.Y.), Kuala Lumpur, Malaysia; and Eye Institute of Xiamen University (Z.L.), Xiamen, China; and Department of Ophthalmology (J.S.), Tokyo Dental College, Ichikawa, Japan.


The 2017 consensus report of the Asia Dry Eye Society (ADES) on the definition and diagnosis of dry eyes described dry eye disease as "Dry eye is a multifactorial disease characterized by unstable tear film causing a variety of symptoms and/or visual impairment, potentially accompanied by ocular surface damage." The report emphasized the instability of tear film and the importance of visual dysfunction in association with dry eyes, highlighting the importance of the evaluation of tear film stability. This report also discussed the concept of tear film-oriented therapy, which stemmed from the definition, and which is centered on provision of insufficient components in each tear film layer and ocular surface epithelium. The current ADES report proposes a simple classification of dry eyes based on the concept of tear film-oriented diagnosis and suggests that there are three types of dry eye: aqueous-deficient, decreased wettability, and increased evaporation. It is suggested that these three types respectively coincide with the problems of each layer: aqueous, membrane-associated mucins, and lipid/secretory mucin. Although each component cannot be quantitatively evaluated with the current technology, a practical diagnosis based on the patterns of fluorescein breakup is recommended. The Asia Dry Eye Society classification report suggests that for a practical use of the definition, diagnostic criteria and classification system should be integrated and be simple to use. The classification system proposed by ADES is a straightforward tool and simple to use, only through use of fluorescein, which is available even to non-dry eye specialists, and which is believed to contribute to an effective diagnosis and treatment of dry eyes.

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