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A Valuable Dry Eye Education Tool for Clinicians and Patients: The TFOS Lifestyle Report

The multifactorial nature of ocular surface disease continues to present challenges for eye care practitioners who want effective management strategies for their patients. With so many factors contributing to DED—environmental, lifestyle, nutritional, hormonal, pharmacological, etc.—physicians need evidence-based data to guide their patients in making or breaking daily habits that can ease or exacerbate their condition. “Ocular surface disease is so complex, it almost warrants its own subspecialty,” Christopher E. Starr, MD, told Dr. Singh.

Dr. Starr is a global ambassador and US affiliate for the Tear Film and Ocular Surface Society (TFOS), a nonprofit organization that facilitates research and education on ocular health. The organization’s most recent series of publications, “A Lifestyle Epidemic: Ocular Surface Disease,” focuses on lifestyle behaviors that have been shown in research to contribute to ocular surface disease.1 These behaviors include digital eye strain, the use of cosmetics, nutritional deficiencies, contact lens use, and others. “The task here was to look at all the evidence-based literature published over the past 10 years relating to decisions that patients make on a daily basis that can impact the health of their eyes and ocular surfaces, such as cosmetics, nutrition, and digital screen usage,” explained Dr. Starr. This undertaking required 158 noted researchers and experts from 38 countries, as well as a subcommittee to evaluate the quality of the evidence that would be used in the report.

One subcommittee explored the impact that watching/reading screens and devices has on the ocular surface. Notably, they advocated for using the term digital eye strain to describe the “development or exacerbation of recurrent ocular symptoms and/or signs related specifically to digital device screen viewing.”1 In a separate part of the report, the committee reviewed results of an analysis of treatment options for digital eye strain. Interestingly, Dr. Starr noted, the literature review revealed that supplementation with omega-3 essential fatty acids is one of the best ways to combat the symptoms of digital eye strain. Glasses that block blue light, on the other hand, had no measurable effect.

Cosmetic products were the focus of another of the lifestyle subcommittees. In this largely unregulated industry, patients need to be informed and screen labels for ingredients such as formaldehyde (a known carcinogen), BAK, parabens, and other toxins, which may be present at levels many times higher than what has been proven to be damaging to the ocular surface.

Future of the TFOS and Ocular Surface Disease Treatment

Dr. Starr noted that recruitment is already underway for the TFOS DEWS III report. Additionally, he is excited for the recent proliferation in pharmacologic DED treatment options that have come to market this year alone. These include MIEBO (perfluorohexyloctane ophthalmic solution; Bausch + Lomb), with no preservatives and no inactive ingredients, and a new product to treat Demodex blepharitis, lotilaner ophthalmic solution 0.25% (XDEMVY; Tarsus Pharmaceuticals). “There is so much going on in this field that, 10 years from now, I would expect the dry eye literature to double or triple again,” said Dr. Starr. “The role of the TFOS is to evaluate high-quality, evidence-based research to cut through marketing and hyperbole, and that’s why I’m very proud to be a part of it.”

1. Craig JP, Alves M, Wolffsohn JS, et al. TFOS Lifestyle Report Executive Summary: A Lifestyle Epidemic – Ocular Surface Disease. Ocul Surf. 2023;30:240-253.

Christopher E. Starr, MD
  • Associate Professor of Ophthalmology, Director of Refractive Surgery, and Director of Ophthalmic Education, Weill Cornell Medicine, New York-Presbyterian Hospital, New York
  • Member, CRST Editorial Advisory Board
  • cestarr@med.cornell.edu; www.StarrMD.com
  • Financial disclosure: None