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Tear-film-oriented diagnosis for dry eye

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  • Organizer: Mitsuru Sawa, MD, PhD, Kohji Nishida, MD, PhD
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Abstract

Tear-film (TF) stability protects the ocular surface epithelium from desiccation and is ensured via cooperation between the ocular surface components including constituents of the TF and ocular surface epithelium. Thus, when those components are insufficient or impaired, the TF breakup that initiates dry eye occurs. Recently, new, commercially available eye drops have appeared in Japan that enable TF stabilization via targeted supplementation of deficient ocular surface components. Hence, a new layer-by-layer diagnosis and treatment concept for dry eye, termed tear-film-oriented diagnosis and tear-film-oriented therapy (TFOD and TFOT, respectively), have emerged and become widely accepted in Asian countries and beyond. TFOD is a diagnostic method for dry eye based on the TF dynamics and breakup patterns (BUPs), through which dry-eye subtypes, including aqueous-deficient dry eye, decreased-wettability dry eye, and increased-evaporation dry eye, are diagnosed. BUPs and/or each diagnosed dry-eye subtype can, in a layer-by-layer fashion, reveal the insufficient ocular surface components responsible for the TF breakup. Using these data, the optimal topical TFOT to treat dry eye can be proposed by addressing the TF breakup via the supplementation of the insufficient components. In Japan, TF breakup is now regarded as a visible core mechanism of dry eye, and abnormal breakup time (ie, ≤ 5 seconds) and symptoms are currently considered part of the diagnostic criteria for dry eye. In this review, the importance of TF instability as a core manifestation of dry eye, the molecular mechanism of TF breakup, the concept of TFOD, and the methods for implementing TFOD for TFOT are introduced.

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Fig. 1

This scheme can be cited from the homepage (http://www.dryeye.ne.jp/index.html) of the Dry Eye Society in Japan

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Acknowledgements

This study was supported in part by a grant-in-aid for scientific research from the Japanese Ministry of Education, Culture, Sports, Science and Technology (no. 16K11269). The authors wish to thank John Bush for reviewing the manuscript.

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Authors and Affiliations

  1. Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan

    Norihiko Yokoi

  2. Department of Optics and Spectroscopy, Faculty of Physics, St. Kliment Ohridski University of Sofia, Sofia, Bulgaria

    Georgi As Georgiev

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  1. Norihiko Yokoi
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  2. Georgi As Georgiev
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Correspondence to Norihiko Yokoi.

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Conflicts of interest

N. Yokoi, Consultant fees (Alcon, Kissei, Rhoto), Honoraria (Johnson & Johnson Vision Care, Otsuka, Santen), P (Kowa, the patent for ophthalmologic apparatus has been licensed. The patent for an image classifying method is pending.); G. A. Georgiev, None.

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Organizer: Mitsuru Sawa, MD, PhD, Kohji Nishida, MD, PhD.

Corresponding author: Norihiko Yokoi

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Yokoi, N., Georgiev, G.A. Tear-film-oriented diagnosis for dry eye. Jpn J Ophthalmol 63, 127–136 (2019). https://doi.org/10.1007/s10384-018-00645-4

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