Setting goals and treatment objectives, and brimming with sound practical advice, it adopts a clinical decision-making approach to the subject. Management and treatment options are prioritised and based on the practical experience of the authors and others. An essential pocket reference for all students and practitioners treating dry eye conditions including ophthalmologists, optometrists, dispensing opticians, ophthalmic nurses and all those involved in the management of these challenging conditions.
Diagnosing the severity of dry eye: a clear and practical algorithm
Just click on the icons to get to the download page Chrome. Decline Accept. SKU: BK Categories: Contact lenses , Full book list , Optometry. The hierarchy of determinant and contributory factors for each scenario, as determined by panel consensus is outlined in table 3. The specific evaluation pathway for each scenario is discussed below and shown in figure 2. Summary of determinant ie, validated and contributory ie, indicative diagnostic criteria and grading recommended by the ODISSEY panel to be used to establish severe DED in the case of symptom and sign discordance ie, scenario A, B, or C.
Criteria are ranked highest to lowest in order of perceived value for diagnosis.
Inclusion of one or more accepted additional criterion is sufficient to establish DED as severe. If the patient presents significant ocular damage determined by CFS, but symptom severity is relatively mild, the additional presence of one or more of the determinant factors listed in table 3 is sufficient to establish severe DED diagnosis.
The panel noted that in this scenario, diminished corneal sensitivity should also be considered as an additional determinant sign. If symptom score is high, but CFS ocular signs do not quite meet the panel-defined level for severe DED, the panel determined that the presence of one of the additional determinant factors listed in table 3 is sufficient to establish severe DED diagnosis.
However, the algorithm for Scenario B is distinct from Scenario A in that corneal sensitivity is not considered as a determinant factor in this case. This is because the OSDI score already confirms adequate corneal sensitivity. Scenario C represents major discordance between symptoms and CFS grading, and as such, requires particular attention. The panel recommended that if reported symptoms are severe, but there is no immediate correlation with clinical signs as assessed by CFS grade, the diagnosis of DED should be reconsidered but not necessarily discarded.
Use of the TBUT test in this scenario is, therefore, a prerequisite as a preliminary step see figure 2 to evaluate tear film instability and confirm the original diagnosis of DED. A more comprehensive understanding of the patient case is also necessary eg, use of an in-depth patient questionnaire to further determine quality of life, mood evaluation, etc. It is of note that filamentary keratitis is not considered as an additional determinant criteria in the case of Scenario C, as objective ocular symptoms determined by CFS have already been confirmed as mild table 3.
The ophthalmological field requires a reliable algorithm for patient-tailored evaluation of ocular surface damage, enabling definitive diagnosis of severe DED. The vicious circle of DED pathogenesis, which can exacerbate the condition and facilitate merging or development of mechanistically distinct DED subtypes can further hinder accurate evaluation. The ODISSEY scoring algorithm for severe DED diagnosis is a simple, easy-to-use and practical tool, which facilitates assessment of ocular surface damage and evaluation of disease severity.
For patients with symptom and sign dissociation, the evaluation of additional specific criteria are recommended to ascertain disease severity. Several systems for classifying DED severity already exist. The Triple Classification System bases severity on the continuing presence of symptoms, along with increasing signs of disease. There are several limitations to the use of this model. The method of panel-based consensus is by its very nature not necessarily evidence based. Furthermore, the use of specific recommended assessments will heavily depend on local availability, training and cost.
There is also an issue of pre-existing differences in definitions of dry eye. For example, the Japanese recognise a short break-up time, dry eye condition, characterised by very short TBUT and severe symptoms, but with minimal surface damage. The Japanese do not consider this condition severe, however, following the DEWS approach and the algorithm presented here, it would satisfy criteria for diagnosis as severe DED. Nevertheless, by using a hierarchical approach to provide a range of acceptable marker options relevant for each patient it is hoped that, after extensive validation, this algorithm can be broadly applied across a range of clinical and geographical settings.
It is hoped implementation of this tool will help to better define trial outcomes and accelerate clinical development of new treatments. Once validated, this algorithm will also aid the ophthalmologist in patient follow-up and treatment optimisation. The authors would like to thank Scinopsis Medical Writing for their help with this manuscript. Collaborators: Prof.
Michael Lemp. Santen has no input into the meeting and content of this article. Provenance and peer review: Not commissioned; externally peer reviewed. National Center for Biotechnology Information , U. The British Journal of Ophthalmology. Br J Ophthalmol. Published online Mar Gysbert Van Setten 5 St.
Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Dry eye disease DED is a distressing ocular condition. Open in a separate window. The ODISSEY European Consensus Group An algorithm that identifies the criteria most relevant to the patient will allow for targeted evaluation of the ocular surface and facilitate assessment of disease severity.
Step 1: fundamentals of severe DED diagnosis The first step of the scoring algorithm evaluates the minimum number of fundamental criteria required for severe DED diagnosis. Fluorescein is the most common, and is suitable for daily clinical practice. Lissamine Green is almost exclusively used in clinical trials. Measures maximal tear secretion capacity without anaesthesia. Any local change in tear film thickness has the potential to degrade retinal image quality. Not established — Confocal microscopy May provide a non-invasive way to visualise high-resolution histologic-like patterns of the ocular surface structures.
Not established in clinical setting — Aberrometry Objective measurement of the time course of high-order aberrations may constitute an instrument to evaluate and manage patients with DED. Used as a biomarker in clinical trials, not established in clinical setting — Other inflammatory markers MMP9, cytokines, proteomics and Luminex assays.
Does digital screen exposure cause dry eye?-IJCAP
Not well established. Determinant criteria Eight of the criteria were classed as determinant to diagnosis of severe DED, and are listed in table 1. Contributory criteria Contributory criteria are listed in table 2 and include aberrometry, confocal microscopy, inflammatory markers and refractory to standard disease treatments.
Conclusions The ophthalmological field requires a reliable algorithm for patient-tailored evaluation of ocular surface damage, enabling definitive diagnosis of severe DED. Acknowledgments The authors would like to thank Scinopsis Medical Writing for their help with this manuscript. Footnotes Collaborators: Prof.
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