For the busy clinician in ophthalmology, it helps to have some commonly accepted protocols to guide his or her diagnostic and treatment decisions regarding a given disease state. In the arena of ocular surface disease, these protocols have often come in the form of reports from the Tear Film and Ocular Surface Society’s Dry Eye Workshop.
As our understanding of dry eye has evolved over the years, the DEWS has changed too, shedding new light on heretofore unknown aspects of the disease and helping clinicians integrate that new knowledge into their treatment decisions. Recently, the Workshop started a new chapter on dry eye with its latest report, DEWS II.
In addition to a new definition of the disease, which incorporates such concepts as “homeostasis of the tear film” and “neurosensory abnormalities” (which may help explain why signs and symptoms don’t always match up in both the clinic and in large-scale, prospective clinical trials), the researchers in DEWS II also use an exhaustive literature search to ferret out the treatment approaches that work best.
As Senior Editor Christopher Kent points out in his feature on three of the latest dry-eye treatment algorithms (p. 24), the DEWS II protocol tries to impress upon physicians the value of starting out with less intensity—perhaps discussing how the patient’s work and leisure environments might be contributing to his or her dryness—before moving on to more intense treatments such as punctal occlusion. Chris’ article walks the reader through each of the algorithms’ recommendations in a stepwise fashion, allowing the reader to take the concepts back to the clinic immediately.
However, a treatment algorithm is only as good as the treatments that are used. With this in mind, on page 42 of this month’s issue Senior Associate Editor Kristine Brennan gives readers a sneak peak at several dry-eye therapies—one that’s recently become available and others that are still in the research pipeline—that may prove to be game changers in the quest for relief from signs and symptoms. It might pay to save some space for these new approaches in your personal protocol.
As DEWS II writes a new chapter in our ongoing understanding of the ocular surface, another chapter ends. This time, though, it’s much closer to home: After 23 years, Mark B. Abelson, MD, is stepping away from writing our monthly column on ocular therapeutics, Therapeutic Topics. During his tenure with Review—which began with the magazine’s first issue and in which he’s never missed a month—he generously shared his wisdom on topics ranging from dry eye to infection. Taken together, his columns are like a mini-fellowship in the pharmaceutical management of diseases of the anterior segment.
I’d like to take this opportunity to thank Dr. Abelson for his valuable contributions to Review, and for allowing us to take part in the creation of his own unique chapter on ocular care.
—Walt Bethke, Editor in Chief