clinician who has managed a dry eye patient unsuccessfully would
welcome a cookbook approach to diagnosis and treatment. Of course,
this assumes that the given approach works.
experts in any field get together to reach consensus regarding
complicated issues within the field, chaos and professional debate
may ensue. As a result, movement in a forward direction with respect
to the issues is the positive outcome.
past two years, several international groups have met to discuss
consensus within the field of dry eye in an effort to improve
patient care and to collectively move the field forward. Behrens et
al (September 2006 Cornea) highlighted an
approach uncommon in the ophthalmic community: the Delphi approach.
The Delphi Approach
Corporation first developed the Delphi method throughout the 1940s
and 1950s to evaluate military-related trends. In general, a panel
of experts participates in completing surveys and in a facilitated
face-to-face session. Participant responses help identify
conflicting viewpoints, and the ensuing discussion gradually results
in consensus building.
case of the Delphi approach used for dry eye diagnosis and
management, consensus was defined as a two-thirds majority of the 17
panelists, who were selected on the basis of clinical and
peer-reviewed publications and/or presentations.
Controversy Regarding the Term Dry Eye
Delphi approach, the international panel arrived at the term
Dysfunctional Tear Syndrome to characterize the condition. While
perhaps more descriptive and embracing of the concepts critical to
ocular surface disease, this term requires acceptance of a name
change. Within the same issue of Cornea,
an editorial entitled What's in a name? by Baum et al discusses the
pros and cons of adopting a name change, with the ultimate
recommendation that dry eye persist as the term used in defining the
The DEWS Report
report of the Dry Eye Workshop (DEWS), an international taskforce,
is expected to publish this month as a supplement to
The Ocular Surface. This review of
current research, epidemiology, classification of dry eye,
diagnosis, treatment and clinical trials has been on-going for the
past three years and involves more than 60 experts from the cornea
and dry eye clinical and industry community. This document
highlights the significant advances in the field over the last 10+
years (since the 1995 report of the NEI/Industry on Clinical Trials
in Dry Eye by Lemp) and will essentially provide a blueprint for the
forward direction of research for the upcoming decade. In other
words, don't miss it, as it's likely to include the most cited dry
eye documents for the foreseeable future.
Delphi approach and the DEWS process will result in guidelines for
dry eye diagnosis and management that may differ from what currently
occurs in clinical practice. The differences are an opportunity to
open a dialog among clinicians about what really works - and for
what types of patients. This will move the starting block to a
higher level and provide a certain amount of comfort that standards
in clinical care can change, and that such change is welcomed by
clinicians and patients alike.