Read the interview of Prof. Michael A. Lemp.
The field of Dry Eye Disease (DED) research has been very active over the last few decades and the pace has quickened particularly in the last few years. In 2007 the international summation of the state of the field was the Dry Eye Workshop Report (DEWS)1. While this universally accepted document presented an accurate picture of a consensus as to how the disease was viewed by experts in different scientific and medical disciplines, it was clear that there were large gaps in the knowledge base and significant challenges in the following areas: understanding the initiation and progression of the disease process, identifying its essential components, judging severity, designing clinical trials to assess new treatments and confounding variables such as the lack of correlation between objective signs of disease and symptoms.
Over the past five years there has been a considerable literature developed in these areas of research. The two most investigated topics in DED have been inflammation and tear osmolarity. Newer findings have shed much light on the pathophysiology of DED, the relationship between clinical signs and symptoms, newer disease markers, and the development of disease. These findings, which will be summarized here, have led to new fundamental concepts in understanding DED.
Contemporary problems in Dry Eye Disease
This very common condition which affects up to 20% of the population in Europe, North America, and Asia, leads to significant burdens on patients and the societies in which they live2,3. Principal challenges to a better understanding of this disease include:
– There is a poor correlation between objective signs of disease and patient reported symptoms.
– There are frequently disagreements between objective signs of disease particularly in the early stage of disease.
– Conventional endpoints in clinical trials for new therapeutic agents have proven inadequate resulting in almost no new therapeutic agents approved for clinical use despite hundreds of studies.
– There is poor repeatability in most clinical tests for diagnosis.
– Sensitivity and specificity data is contradictory and confusing in many papers.
– While inflammation has been shown to play an important role in the development of DED, many patients exhibit no clinical evidence of inflammation.
Newer concepts in Dry Eye Disease
Addressing these issues has become easier relying on newer data which have given rise to newer concepts which shed considerable light on the character of the disease, its development and severity and may lead the way to more effective management of the disease.
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