Dews II: Great expectations?

Terrific, certainly: consensus on a lexicon and new treatment guidelines would help.

In the decade since DEWS I was published, most ophthalmologists have come to understand what the acronym DED means.Several factors have influenced this shift, such as a significant rise in disease prevalence, professional and public awareness, enormous industry interest, and distinct diagnostic options with treatment successes.

Having treated DED for more than 10 years, I am delighted that we, as a profession, have reached this important juncture in our knowledge of ocular surface disease. But we have much more to learn. The recommendations and conclusions from DEWS II were just released at ARVO; more than 130 international dry eye experts have been collaborating on DEWS II for a long time, and it’s no wonder. We define dry eye as multifactorial for an evidence-based reason. The full report will be published this year.

I and my colleagues hope that the committee members addressed certain areas in the DEWS II report. As attention has shifted to dry eye, issues have arisen, the least of which is an agreed-upon name.


Years ago, the patient thought most likely to develop DED was the stereotypical menopausal woman. We had few treatment options to offer her besides artificial tears.

Oh, what a difference a decade makes. With heightened awareness of this disease and more causes being discovered, dry eye is being diagnosed in younger patients and in both genders. I, for one, am looking forward to better guidelines regarding whom and how often to test, when to retest, and which treatment at which level of severity to recommend.


Clarification of the dry eye-associated lexicon is another area that I eagerly await. Consensus would surely help to define dysfunctional tear syndrome, ocular surface disease, meibomian gland dysfunction or dry eye disease. There are so many descriptors, and without accurate descriptors, it is difficult to get codes. We don’t even have a code for meibomian gland dysfunction, for example, even though we are making that diagnosis a lot.

I am patiently waiting to see if the information DEWS II provides will finally convince payers that DED is real, needs to be diagnosed early and requires prompt treatment. At this point, not all carriers pay for some of the point-of-care testing or for some DED medications. If they did, our lives would be easier and patients would likely be more compliant, not to mention have an improved quality of life. OM