Kudos to the Tear Film and Ocular Surface Society (TFOS) for forming another workgroup on lifestyle issues. For those who may not be familiar with this esteemed group’s work, let me share who they are and highlight some of the many accomplishments they have achieved over the past 15+ years. TFOS, a nonprofit organization, was spearheaded in 2000 by a research group out of Boston led by David Sullivan, PhD, and is “dedicated to advancing research, literacy and educational aspects of the scientific field of the eye’s surface.”1 

Starting with the original Dry Eye (DEWS) publication in 2007, TFOS DEWS significantly expanded the scope of dry eye disease. A decade later DEWS II, a 350+ page report, redefined our definition of dry eye and looked at many of the key components of the disease process revamping guidance for diagnostic methodologies and treatment modalities.2 All of their reports are available in complete or at least partial translation in numerous languages, such as French, Italian, German, Spanish, Chinese, Korean, Portuguese, Vietnamese, Romanian and Turkish.3

Dry Eye Reminder

TFOS DEWS II defines dry eye as the following: “Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage and neurosensory abnormalities play etiologic roles.”2 Significant additions to the first DEWS report included the recognition of loss of homeostasis and added neurosensory abnormalities as an etiologic component to dry eye disease.2 TFOS DEWS II also highlighted the whole spectrum of the disease process rather than locking into two distinct, separate classifications (aqueous deficient vs. evaporative).4

The DEWS II report emphasizes the importance of an accurate differential diagnosis to assure appropriate treatments. Added significance is given to the fact that signs and symptoms in dry eye disease don’t often correlate well. 

Diagnostic procedures or tools are recommended using valid patient questionnaires and homeostasis markers, such as tear film break-up time, hyperosmolarity and staining of the conjunctiva and cornea. 

The description of the tear film layers are typically described as a three-layer system. The report clarifies this by depicting a two-layered ecosystem composed of a muco-aqueous and an outer lipid layer.2,4 Additionally, the report offers a very comprehensive and effective step-wise approach for management (see complete report).4

Beyond DEWS II

This sets the stage and brings us to the next TFOS project, “A Lifestyle Epidemic: Ocular Surface Disease,” which will address the challenges of the vision compromising problems associated with dry eye and other ocular surface diseases. TFOS groups have always been interested in identifying the gaps in research and then addressing the deficiencies in what we know or don’t know to ask. 

TFOS has assembled a task force of international experts with several workgroups and subcommittees that will focus on timely topics such as digital eyestrain, cosmetics, nutrition, self-iatrogenesis, environment, lifestyle challenges, contact lenses, societal challenges and public awareness.

One of the subcommittees, the Contact Lens workgroup, will be chaired by Lyndon Jones, FCOptom, PhD, professor of optometry at University of Waterloo in Canada. Some of the anticipated topic areas will be:

  • lifestyle choices that directly or indirectly impact the ocular surface
  • lifestyle choices that affect the overall performance of contact lens wear
  • the impact of coexisting disease (along with dry eye disease) on contact lens performance

I’m sure you will join me in welcoming this new initiative and look forward to another extremely valuable end-product from highly skilled and exceedingly capable international experts working in each subcommittee.

1. TFOS – Tear Film & Ocular Surface Society. www.tearfilm.org. Accessed October 1, 2021. 
2. Winebrake JP, Drinkwater OJ, Brissette AR, Starr CE. The TFOS dry eye workshop ii: key updates. Eyenet. www.aao.org/eyenet/article/the-tfos-dry-eye-workshop-II. November 2017. Accessed October 1, 2021. 
3. TFOS. TFOS DEWS II report. www.tearfilm.org/dettreports-tfos_dews_ii_report/7259_7248/eng. Accessed October 1, 2021.  
4. Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276-83.