TFOS and the progress of scientific knowledge about ocular surface disease

To promote further progress in this field of vision research, the Tear Film & Ocular Surface Society (TFOS; www.tearfilm.org) was created and incorporated as a non-profit organization in 2000. The purpose of this Society is to advance the research, literacy, and educational aspects of the scientific field of the tear film and ocular surface.
Since its incorporation, TFOS has launched numerous initiatives, including:
– organization of International Conferences on the Tear Film and Ocular Surface in Maui in November 2000 (310 participants, 233 presentations), Puerto Rico in 2004 (400 participants, 270 presentations), Taormina, Italy, in 2007 (500 participants and 261 presentations), Florence, Italy, in 2010 (600 participants and almost 300 presentations), and Taormina, Italy in 2013 (500 participants and 256 presentations)
– organization and sponsorship of the TFOS International Dry Eye WorkShop (DEWS), and publication of the TFOS DEWS report in The Ocular Surface
– organization and sponsorship of the TFOS International Workshop on Meibomian Gland Dysfunction (MGD), and publication of this TFOS MGD Workshop report in Investigative Ophthalmology & Visual Science
– organization and sponsorship of the TFOS International Workshop on Contact Lens Discomfort (CLD), and publication of this TFOS CLD Workshop report in Investigative Ophthalmology & Visual Science
– publication of a 1,385-page book (Adv Exp Med Biol 2002, vol 506A & B) about the tear film and ocular surface in health and disease ?
– sponsorship of the peer-reviewed journal, The Ocular Surface, and facilitation of its growth into one of the highest ranked ophthalmic journals in the world
– awarding of more than 200 Young Investigator Travel Awards
In addition, TFOS activities have helped to promote increased international awareness of external eye diseases, enhance governmental funding for tear film and ocular surface research, stimulate the development of therapeutic drugs and diagnostic devices, and influence the design and conduct of clinical trials of novel treatments for ocular surface disorders.
At present, TFOS has a distribution to ~ 5,000 basic scientists, clinical researchers and industry representatives in more than 80 countries.

The three reports TFOS released since 2007 have deeply influenced the trends of development of scientific knowledge in each of their specific field. Let us ask a few questions about them. First of all, in 2007 DEWS proposed a new definition of dry eye disease and a classification which retains the etiopathogenic distinction in “aqueous tear-deficient dry eye” and “evaporative dry eye”. What has been its impact?
The TFOS Dry Eye WorkShop (DEWS) was created to provide an evidence-based critical review of the definition, classification, epidemiology, diagnosis, management, and research techniques of dry eye disease. The DEWS impact has been amazing.
As noted by Gary Foulks, MD, an internationally renowned ophthalmologist, “The publication of the Dry Eye WorkShop (DEWS) Report…was a landmark event in the history of our understanding and treatment of dry eye disease” (http://www.refractiveeyecare.com/2012/12/the-dews-report-in-perspective/). ?
Indeed, I believe that the online TFOS DEWS report has been opened tens of thousands times by people from around the world. According to an industry representative, the TFOS DEWS report is called the dry eye “Bible” by a European Medicines Agency official. Further, European pharmaceutical companies seeking guidance on how best to conduct a clinical trial have been directed to read this report.?
Michael Lemp, MD, stated “The TFOS DEWS report stands as a landmark resource for clinicians and researchers seeking to understand contemporary thinking on virtually all aspects of dry eye disease. In one document you can find the world literature summarized, the consensus of the world’s experts presented, and practical guidelines for evaluating and treating patients. I regard it as an essential part of the library for anyone interested in understanding and applying current concepts in the diagnosis and management of dry eye disease” (http://www.visioncareeducation.com/no-feece/course6.asp).

Has our approach to Meibomian Gland Dysfunction changed in these last years?
In a recent report by Drs. Amber G. Gainnoni and Jason Nichols (http://www.clspectrum.com/articleviewer.aspx?articleID=107175), an impressive 76% of surveyed clinicians are now evaluating meibomian glands as part of their testing for dry eye disease. This is a greater percentage than in previous years and was attributed to publication of the TFOS Meibomian Gland Dysfunction (MGD) Workshop report. It is now well recognized that MGD is the major cause of dry eye.

TFOS latest report is focused on Contact Lens Discomfort: how are its definitions and recommendations a step forward in the knowledge and management of this condition in health and disease?
Contact Lens Discomfort (CLD) may be the leading cause of patient dissatisfaction with, and discontinuation of, contact lens wear throughout the world. But, until last October’s publication of the TFOS International Workshop on Contact Lens Discomfort report (www.tearfilm.org), there was little agreement among vision researchers and eye care professionals about how to define and manage its causes. Furthermore, even though half of all contact lens wearers experience CLD, there was no global consensus concerning the classification, epidemiology, pathophysiology, diagnosis, and the proper design of clinical studies for CLD.
To achieve such a consensus, TFOS sponsored this CLD Workshop that took 18 months to complete and involved 79 experts from around the world. The Workshop participants used an evidence-based approach and a process of open communication, dialogue, and transparency in order to achieve a global consensus concerning multiple aspects of CLD.
This TFOS report not only defined CLD, but will significantly increase awareness of factors that may, and may not, contribute to the generation of CLD. Ideally, this TFOS report will stimulate innovative research in this very important field.

David A. Sullivan
E-mail: David_Sullivan@meei.harvard.edu

David A. Sullivan is Associate Professor in the Department of Ophthalmology at Harvard Medical School (HMS) and a Senior Scientist at the Schepens Eye Research Institute (SERI). He is a founder and recent President of the Tear Film & Ocular Surface Society (TFOS).
His research and academic activity has always been focused on the ocular surface and, in particular, upon the understanding of dry eye disease and the development of its potential therapies.

All TFOS reports are available on TFOS website: www.tearfilm.org