dry eye dx and tx
Is it Possible to Achieve Consensus in Dry Eye?
Any 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.
When 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.
Over the 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
The Rand 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.
In the 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
Using the 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 disorder.
The DEWS Report
The 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.
Both the 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.
Dr. Nichols is an associate professor at The Ohio State University College of Optometry in the area of dry eye research.