Oct 2016

SPECIAL FEATURE: DRY EYE
Dry eye: a hot topic
A
week doesn’t go by without someone
issuing a press release or circulating a paper
where dry eye diagnosis or treatment is the
topic. More and more companies are developing
new technologies or introducing software
upgrades to tackle the thorny issue of dry eye.
There’s still much debate, however, about what
works and what doesn’t as will become evident in
the following articles in this special feature.
But knowledge about dry eye has grown
exponentially over the past decade, fuelled by
research following the internationally-renowned
Tear Film & Ocular Society’s Dry Eye Workshop
(DEWS), which was instrumental in bringing the
problem to the fore by developing a common
starting platform from which organisations
could develop products and researchers could
undertake new research. Out went the old
definitions, deemed inadequate, and in came a
new consensus definition:
Dry eye is 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.
It’s pleasing to note how
New Zealand, together with
our trans-Tasman neighbour,
is leading a lot of the research
out there and there’s more
to come with the results
of DEWS II, the second Dry
Eye Workshop, expected
in the next few years, with
preliminary results being
discussed at the TFOS meeting
in Montpellier in France,
ongoing at the time of this
feature’s publication.
EDITORIAL BY LESLEY SPRINGALL
Acknowledgements
With that in mind, NZ Optics would like to thank
the authors of all the contributed articles in this
feature for updating us about their research,
their progress and their interesting and personal
take on the treatments and diagnosis of dry eye
and the tools available (as well as some of their
own invention – see Greg Nel’s article about his
ping pong ball tearscope on p14). Their stories
provide a breadth of understanding about where
we’re at with dry eye and where we’re going and
it’s a privilege to be able to curate and present
these articles here.
Special thanks must also go to New Zealand’s
own dry eye expert, Associate Professor Jennifer
Craig, vice-chair of DEWS II and passionate
researcher into all things dry eye, who was
instrumental in helping to curate and review the
following articles, which we both hope will serve
to enlighten and inform current thinking on the
increasingly hot topic of dry eye.
TFOS imagery used to launch the now highly anticipated DEWS II
TFOS, OSL and where we are
with dry eye
BY ASSOCIATE PROFESSOR JENNIFER CRAIG*
The Tear Film and Ocular Surface Society
(TFOS) is a non-profit society created in
2000 with a network that extends to more
than 85 countries. As such, it represents a global
community whose mission is to advance the
research, literacy and educational aspects of the
scientific field of the tear film and ocular surface.
Since the initial International Conferences on the
Lacrimal Gland, Tear Film and Dry Eye Syndromes
in 1992 and 1996 in Bermuda, the incorporated
TFOS Society has continued to organise meetings,
initially every four years and now every three, with
the latest meeting held as this article goes to press
in Montpellier, France. These vibrant meetings
provide a forum for critically appraising current
knowledge and the latest research on the ocular
surface, and promoting international exchange
of information and ideas between scientists,
academic clinicians and industry representatives
dedicated to understanding the field and
ultimately to improving patient care.
At the time of writing, the current meeting is
shaping up to be the best yet, with an impressive
line-up of presenters promising to provide insight
into the unique challenges and unmet needs for
the treatment of ocular surface disease across the
different regions of the globe; and many topical
matters such as sex-differences in dry eye and the
role of neuropathic pain in the disease. Debates
provide insight into topical concepts and around
250 posters will be presented across the three full
days of the meeting.
Beyond the conferences, TFOS is undoubtedly
best known for the International Workshops it has
sponsored; the Dry Eye Workshop (DEWS, 2007), the
Meibomian Gland Dysfunction Workshop (MGDW,
2011) and the Contact Lens Discomfort Workshop
(CLDW, 2013). Critical to these workshops has been
an evidence-based approach to achieving global
consensus, with open communication, dialogue
and transparency. It is with this charge, that 150
clinical and scientific experts have come together,
under the organisation of Associate Professor
David Sullivan, TFOS founder and Harvard senior
scientist, and the
leadership of Dr
Dan Nelson, chair of
the Workshop, and
myself, as vice-chair,
to compile DEWS
II, an update on dry
eye from the 10
years of research
published since the
original DEWS.
The conference in
Montpellier is the
first opportunity to
hear some of the
DEWS II findings
presented in an
Associate Professor Jennifer Craig
vice-chair of DEWS II
open forum. So it’s pleasing to see that there will
be a sizeable Australasian contingent attending,
reflecting the volume and quality of research being
conducted in dry eye within Australia and New
Zealand. In particular, there will be representation
from the University of New South Wales (UNSW)
research group, which includes Dr Maria Markoulli
and Dr Laura Downie’s laboratory in Melbourne
(see stories later in this feature), as well as
from the Ocular Surface Laboratory within the
Department of Ophthalmology at the University of
Auckland in New Zealand.
Ocular Surface Laboratory (OSL) update
The last year or so has seen significant expansion
in the size of the OSL team, which now comprises
12 full-time and part-time individuals that include
registered PhD students, MSc students and Honours
students (in medicine, optometry and physics),
as well as postgraduate optometrists (including
Grant Watters – see story p14) and undergraduate
medical students who undertake collaborative
research projects in their spare time, under the
guidance and leadership of post-doctoral researcher
Dr Isabella Cheung and myself. Cheung brings a
wealth of laboratory research skills to the team, to
complement the clinical research expertise.
CONTINUED ON PAGE 10
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