Dry eye disease (DED) is a highly prevalent, chronic and progressive condition that affects 5–33% of the world’s adult population [1]. The 1995 definition of DED only considered patient-reported symptoms (ocular discomfort) and damage to the inter-palpebral ocular surface [2]. However, as it became apparent that this failed to reflect the complexity of the disease and its impact on visual function, inducing a risk of under-diagnosis, the 2007 International Dry Eye WorkShop (DEWS) redefined it as follows: “A multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface” [3]. This introduced the concept that the ocular surface is a single system, added visual disturbances to the symptoms of ocular discomfort and drew attention to the key concepts of inflammation and tear hyperosmolarity. Subsequently, as it is not unusual in everyday clinical practice to encounter patients with moderate–severe symptoms who have no pathological signs on the ocular surface or, conversely, patients with severe signs who are asymptomatic because of decreased corneal sensitivity, DEWS II revised its definition to read “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 etiological roles” [4] in order to indicate the occurrence of corneal nerves impairment, too. The symptoms characterizing the disease can severely affect the patients’ quality of life and everyday activities such as reading, driving or working on a computer [5–8] and are also associated with high levels of anxiety and depression [9]. Consequently, it is not only important to prescribe the appropriate treatment, but also to monitor its effects over time in order to ensure long-term relief and prevent disease chronicity [10,11]. Clinicians are clearly aware of the need to adopt a standardized approach to diagnose and treat DED that includes counselling, patient education and the establishment of a medical alliance to promote effective treatment [12,13]. The aim of this paper is to describe the process used by a group of Italian ophthalmologists (“Italian Dry Eye Consensus Group”) focused on DED for identifying four major statements related to the disease aimed at improving overall DED patient care [14]. Given the complexity of the disease and the different clinical contexts in which it may occur, the method used was based on real-life experience, as well as scientific data, and allowed the consideration of areas of still uncertain or unproven knowledge that may nevertheless help to guide everyday clinical practice and future research.

The Management of Dry Eye Disease: Proceedings of Italian Dry Eye Consensus Group Using the Delphi Method

Giannaccare, Giuseppe
;
2022-01-01

Abstract

Dry eye disease (DED) is a highly prevalent, chronic and progressive condition that affects 5–33% of the world’s adult population [1]. The 1995 definition of DED only considered patient-reported symptoms (ocular discomfort) and damage to the inter-palpebral ocular surface [2]. However, as it became apparent that this failed to reflect the complexity of the disease and its impact on visual function, inducing a risk of under-diagnosis, the 2007 International Dry Eye WorkShop (DEWS) redefined it as follows: “A multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface” [3]. This introduced the concept that the ocular surface is a single system, added visual disturbances to the symptoms of ocular discomfort and drew attention to the key concepts of inflammation and tear hyperosmolarity. Subsequently, as it is not unusual in everyday clinical practice to encounter patients with moderate–severe symptoms who have no pathological signs on the ocular surface or, conversely, patients with severe signs who are asymptomatic because of decreased corneal sensitivity, DEWS II revised its definition to read “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 etiological roles” [4] in order to indicate the occurrence of corneal nerves impairment, too. The symptoms characterizing the disease can severely affect the patients’ quality of life and everyday activities such as reading, driving or working on a computer [5–8] and are also associated with high levels of anxiety and depression [9]. Consequently, it is not only important to prescribe the appropriate treatment, but also to monitor its effects over time in order to ensure long-term relief and prevent disease chronicity [10,11]. Clinicians are clearly aware of the need to adopt a standardized approach to diagnose and treat DED that includes counselling, patient education and the establishment of a medical alliance to promote effective treatment [12,13]. The aim of this paper is to describe the process used by a group of Italian ophthalmologists (“Italian Dry Eye Consensus Group”) focused on DED for identifying four major statements related to the disease aimed at improving overall DED patient care [14]. Given the complexity of the disease and the different clinical contexts in which it may occur, the method used was based on real-life experience, as well as scientific data, and allowed the consideration of areas of still uncertain or unproven knowledge that may nevertheless help to guide everyday clinical practice and future research.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11584/419763
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