Importance of TFOS DEWS II algorithm in dry eye disease diagnosis highlighted
Using the standardized Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) diagnostic algorithm, which combines symptoms, tear film evaluation, and ocular surface signs, is crucial for accurately diagnosing dry eye disease (DED), according to a study that found that omitting any of these components significantly reduces diagnostic sensitivity.
Researchers systematically evaluated how including or excluding tear film homeostasis tests influenced DED diagnosis using data from 1,427 participants across 5 clinical sites.
The study adhered to the TFOS DEWS II diagnostic algorithm, analyzing diagnostic sensitivity when specific tests were omitted or combined.
Researchers found that relying on just 1 of the 3 homeostatic markers led to 12.3%-36.2% of DED cases being undiagnosed. The most sensitive combination for diagnosis was symptoms paired with comprehensive ocular surface staining (87.7%). However, sensitivity plummeted to 44.6% when only corneal staining was assessed.
Requiring symptoms alongside 2 or all 3 homeostatic signs significantly reduced the prevalence of diagnosed DED, by 43.7%-61.2% and 65.9%, respectively. These trends were consistent across varying symptom severities.
Reference
Wolffsohn JS, Travé-Huarte S, Stapleton F, et al. Relative importance of tear homeostatic signs for the diagnosis of dry eye disease. Ocul Surf. 2025;36:151-155. doi: 10.1016/j.jtos.2025.01.010. Epub ahead of print. PMID: 39848540.