In this interview, Prof. David A. Sullivan retraces the most significant steps that have marked the progress of scientific knowledge of the ocular surface and the pathologies that can affect it in recent decades.
Since Prof. Sullivan also played a primary role in the establishment and activity of TFOS (Tear Film & Ocular Surface Society), he is certainly the most qualified personality to explain the contribution this organisation has made to this progress.
In order to promote further progress in this area of vision research, the Tear Film & Ocular Surface Society (TFOS; www.tearfilm.org) was established as a non-profit organisation in 2000. The aim of this Society is to advance research, studies and educational aspects in the scientific area dealing with tear film and ocular surface.
Since its establishment, TFOS has initiated numerous initiatives, which include:
- the organisation of International Conferences on Lacrimal Film and the Ocular Surface in Maui in November 2000 (310 participants, 233 lectures), in Puerto Rico in 2004 (400 participants, 270 lectures), in Taormina, Italy, in 2007 (500 participants, 261 lectures), in Florence, Italy, in 2010 (600 participants, almost 300 lectures), and again in Taormina, Italy, in 2013 (500 participants, 256 lectures)
- organisation and sponsorship of the TFOS International Dry Eye WorkShop (DEWS) and the publication of the related report on The Ocular Surface
- organisation and sponsorship of the TFOS International Workshop on Meibomian Gland Dysfunction (MGD) and the publication of the related report on Investigative Ophthalmology & Visual Science
- organisation and sponsorship of the TFOS International Workshop on Contact Lens Discomfort (CLD) and the publication of the related report on Investigative Ophthalmology & Visual Science
- the publication of a 1,385-page volume (Adv Exp Med Biol 2002, vol 506A & B) on the tear film and the ocular surface in healthy and pathological conditions.
- sponsorship of the peer-reviewed journal The Ocular Surface and support its rise to one of the highest ranking ophthalmology journals in the world.
- the presentation of more than 200 Young Investigator Travel Awards
In addition, TFOS activities have been instrumental in promoting international awareness of external eye diseases, increasing government funding for tear film and ocular surface research, stimulating the development of drug therapies and diagnostic devices, and influencing the design and management of clinical trials of new treatments for ocular surface diseases.
TFOS currently has ~5,000 basic scientists, clinical researchers and industry representatives in more than 80 countries.
The three reports that TFOS has released since 2007 have profoundly influenced trends in the development of scientific knowledge, each in its own specific field. We would like to ask a few questions about them. Firstly, in 2007 the DEWS proposed a new definition of dry eye and a classification that maintained the etiopathogenetic distinction into 'dry eye from reduced tear production' e "evaporative dry eye. What was its impact?
The TFOS Workshop on Dry Eye (DEWS) was organised to provide a critical, evidence-based review of the definition, classification, epidemiology, diagnosis, management and research techniques of dry eye. The impact of the DEWS was astounding.
As internationally renowned ophthalmologist Dr Gary Foulks observed "The publication of the Dry Eye WorkShop (DEWS) Report... was a milestone in the history of our understanding and treatment of dry eye" (http://www.refractiveeyecare.com/2012/12/the-dews-report-in-perspective/).
I truly believe that the TFOS DEWS report available online has been opened tens of thousands of times by people in all parts of the world. According to an industry representative, the TFOS DEWS report is called the 'Bible' of dry eye by an official of the European Medicines Agency. Furthermore, European pharmaceutical companies looking for guidance on how best to conduct a clinical trial were prompted to consult this report.
Prof. Michael Lemp stated "The report of DEWS from TFOS is a key reference for clinicians and researchers seeking to understand current thinking on virtually all aspects of dry eye. In one document you can find a summary of the world literature, the consensus of international experts and practical guidelines for evaluating and treating patients. I regard it as an essential part of the library of anyone interested in understanding and applying the latest concepts in dry eye diagnosis and management' (http://www.visioncareeducation.com/no-feece/course6.asp).
Has our approach to Meibomian Gland Dysfunction changed in recent years?
In a recent study by Drs. Amber G. Gainnoni and Jason Nichols (http://www.clspectrum.com/articleviewer.aspx?articleID=107175), an impressive 76% of the clinicians surveyed are currently assessing the Meibomian glands as part of their dry eye tests. This percentage is much higher than in previous years and is attributed to the publication of the TFOS Workshop report on Meibomian Gland Dysfunction (MGD). It is now widely recognised that MGD is among the main causes of dry eye.
The latest TFOS report focuses on Contact Lens Discomfort: how do the definitions and recommendations in this report represent a step forward in the knowledge and management of this condition, both in health and disease?
Contact Lens Discomfort (CLD) may be a major cause of patient disaffection and discontinuation of contact lens wear worldwide. However, until the publication last October of the TFOS report on the International Workshop on Contact Lens Discomfort (www.tearfilm.org), there was little agreement among researchers and eye care specialists on how to define and manage its causes. Furthermore, despite the fact that half of all contact lens wearers experience CLD, there was no consensus global classification, epidemiology, pathophysiology, diagnosis and the correct design of clinical trials for CLD.
To reach this consensus, TFOS sponsored this CLD Workshop that took 18 months to conclude and involved 79 experts from around the world. Workshop participants used an evidence-based approach and a process of open communication, dialogue, and transparency in order to reach a global consensus on the multiple aspects of CLD.
This TFOS report has not only defined CLD, but will significantly increase awareness of the factors that can and cannot contribute to the onset of CLD.
From an ideal point of view, 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 of Ophthalmology at Harvard Medical School (HMS) and Senior Scientist at the Schepens Eye Research Institute (SERI).
He was among the founders and presidents of the Tear Film & Ocular Surface Society (TFOS).
His academic and research work has always focused on the ocular surface and, in particular, on understanding dry eye and developing potential therapies for its treatment.
All TFOS reports are available on the site: www.tearfilm.org
Dr. Carmelo Chines
Direttore responsabile
