TFOS DEWS III: Digest

Fiona Stapleton¹, Pablo Argüeso², Penny Asbell³, Dimitri Azar⁴, Charles Bosworth⁵, Wei Chen⁶, Joseph B Ciolino⁷, Jennifer P Craig⁸, Juana Gallar⁹, Anat Galor¹⁰, José A P Gomes¹¹, Isabelle Jalbert¹², Ying Jie¹³, Lyndon Jones¹⁴, Kenji Konomi¹⁵, Yang Liu¹⁶, Jesus Merayo-Lloves¹⁷, Fabiola R Oliveira¹⁸, Victor L Perez¹⁹, Eduardo M Rocha²⁰, Benjamin D Sullivan²¹, David A Sullivan²², Jelle Vehof²³, Susan Vitale²⁴, Mark Willcox¹², James S Wolffsohn²⁵, Murat Dogru²⁶

Affiliations

¹ From the School of Optometry and Vision Science (F.S., P.As., I.J., M.W.), UNSW Sydney, New South Wales, Australia. Electronic address: f.stapleton@unsw.edu.au.
² Department of Ophthalmology (P.Ar.), Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
³ From the School of Optometry and Vision Science (F.S., P.As., I.J., M.W.), UNSW Sydney, New South Wales, Australia; Biomedical Engineering (P.As.), University of Memphis, Memphis, USA.
⁴ Chicago College of Medicine (D.A.), University of Illinois, Chicago, IL, USA.
⁵ Azura Ophthalmics (C.B.), Tel Aviv, Israel.
⁶ Eye Hospital of Wenzhou Medical University (W.C.), National Eye Clinic Research Center, People's Republic of China.
⁷ Cornea Service (J.B.C.), Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
⁸ Department of Ophthalmology (J.P.C.), Aotearoa, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.
⁹ Ocular Neurobiology Group (J.G.), Instituto de Neurociencias, Universidad Miguel Hernández-Consejo Superior de Investigaciones Científicas, San Juan de Alicante, Spain.
¹⁰ Surgical Services (A.G.), Miami Veterans Affairs Hospital, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
¹¹ Department of Ophthalmology and Visual Sciences (J.A.P.G.), Paulista School of Medicine / Federal University of São Paulo, São Paulo, Brazil.
¹² From the School of Optometry and Vision Science (F.S., P.As., I.J., M.W.), UNSW Sydney, New South Wales, Australia.
¹³ Beijing Institute of Ophthalmology (Y.J.), Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology & Visual Sciences Key Laboratory (Y.J.), Beijing, China.
¹⁴ Centre for Ocular Research & Education (CORE) (L.J.), School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.
¹⁵ Clinical and Translational Research Center (K.K.), Keio University Hospital, Tokyo, Japan.
¹⁶ Department of Ophthalmology (Y.L.), Zhongnan Hospital of Wuhan University, Wuhan, China.
¹⁷ Instituto Universitario Fernandez-Vega (J.M.-L.), Universidad de Oviedo, Principality of Asturias, Spain.
¹⁸ Department of Clinical Medicine (F.R.O.), Division of Rheumatology and Clinical Immunology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil.
¹⁹ Department of Ophthalmology (V.A.P.Q.), University of Miami Miller School of Medicine, Miami, Florida, USA.
²⁰ Department of Ophthalmology (E.M.R.), Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil.
²¹ Lµbris BioPharma (B.D.S.), LLC, Naples, Florida, USA; Bausch & Lomb (B.D.S.), Bridgewater, New Jersey, USA.
²² Tear Film and Ocular Surface Society (D.A.S.), Boston, Massachusetts, USA.
²³ Departments of Ophthalmology and Epidemiology (J.V.), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Ophthalmology (J.V.), Vestfold Hospital Trust, Tønsberg, Norway.
²⁴ Division of Epidemiology and Clinical Applications (S.V.), National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.
²⁵ College of Health & Life Sciences (J.W.), School of Optometry, Aston University, Birmingham, United Kingdom.
²⁶ Dept of Ophthalmology (M.D.), Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Chiba, Japan.

PMID: 40472874
DOI: 10.1016/j.ajo.2025.05.040

Free article

Review

TFOS DEWS III: Digest

Fiona Stapleton et al. Am J Ophthalmol. 2025 Nov.

Free article

. 2025 Nov:279:451-553.

doi: 10.1016/j.ajo.2025.05.040. Epub 2025 Jun 4.

Authors

Affiliations

¹ From the School of Optometry and Vision Science (F.S., P.As., I.J., M.W.), UNSW Sydney, New South Wales, Australia. Electronic address: f.stapleton@unsw.edu.au.
² Department of Ophthalmology (P.Ar.), Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
³ From the School of Optometry and Vision Science (F.S., P.As., I.J., M.W.), UNSW Sydney, New South Wales, Australia; Biomedical Engineering (P.As.), University of Memphis, Memphis, USA.
⁴ Chicago College of Medicine (D.A.), University of Illinois, Chicago, IL, USA.
⁵ Azura Ophthalmics (C.B.), Tel Aviv, Israel.
⁶ Eye Hospital of Wenzhou Medical University (W.C.), National Eye Clinic Research Center, People's Republic of China.
⁷ Cornea Service (J.B.C.), Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
⁸ Department of Ophthalmology (J.P.C.), Aotearoa, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.
⁹ Ocular Neurobiology Group (J.G.), Instituto de Neurociencias, Universidad Miguel Hernández-Consejo Superior de Investigaciones Científicas, San Juan de Alicante, Spain.
¹⁰ Surgical Services (A.G.), Miami Veterans Affairs Hospital, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
¹¹ Department of Ophthalmology and Visual Sciences (J.A.P.G.), Paulista School of Medicine / Federal University of São Paulo, São Paulo, Brazil.
¹² From the School of Optometry and Vision Science (F.S., P.As., I.J., M.W.), UNSW Sydney, New South Wales, Australia.
¹³ Beijing Institute of Ophthalmology (Y.J.), Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology & Visual Sciences Key Laboratory (Y.J.), Beijing, China.
¹⁴ Centre for Ocular Research & Education (CORE) (L.J.), School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.
¹⁵ Clinical and Translational Research Center (K.K.), Keio University Hospital, Tokyo, Japan.
¹⁶ Department of Ophthalmology (Y.L.), Zhongnan Hospital of Wuhan University, Wuhan, China.
¹⁷ Instituto Universitario Fernandez-Vega (J.M.-L.), Universidad de Oviedo, Principality of Asturias, Spain.
¹⁸ Department of Clinical Medicine (F.R.O.), Division of Rheumatology and Clinical Immunology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil.
¹⁹ Department of Ophthalmology (V.A.P.Q.), University of Miami Miller School of Medicine, Miami, Florida, USA.
²⁰ Department of Ophthalmology (E.M.R.), Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil.
²¹ Lµbris BioPharma (B.D.S.), LLC, Naples, Florida, USA; Bausch & Lomb (B.D.S.), Bridgewater, New Jersey, USA.
²² Tear Film and Ocular Surface Society (D.A.S.), Boston, Massachusetts, USA.
²³ Departments of Ophthalmology and Epidemiology (J.V.), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Ophthalmology (J.V.), Vestfold Hospital Trust, Tønsberg, Norway.
²⁴ Division of Epidemiology and Clinical Applications (S.V.), National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.
²⁵ College of Health & Life Sciences (J.W.), School of Optometry, Aston University, Birmingham, United Kingdom.
²⁶ Dept of Ophthalmology (M.D.), Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Chiba, Japan.

PMID: 40472874
DOI: 10.1016/j.ajo.2025.05.040

Abstract

This digest summarizes the interdisciplinary research in dry eye disease (DED) published since the 2017 TFOS DEWS II reports. It comprises 7 topics including Sex, Gender, and Hormones; Epidemiology; Pathophysiology; Tear Film; Pain and Sensation; Iatrogenic Dry Eye; and Clinical Trial Design and explores how each of these inform diagnostic methodology, disease subtype, and management of DED. Sex- and gender-related differences significantly influence the ocular surface due to hormones, sex chromosomes, sex-specific autosomal factors, epigenetics, care-seeking behaviors, and service use. Epidemiologic data reveal that DED prevalence varies by age and sex, influenced by diagnostic criteria and the multifactorial nature of the disease. New risk factors for DED include environmental, iatrogenicity, systemic diseases, and lifestyle domains. Pathophysiological distinctions between aqueous deficient and more evaporative forms of DED have been clarified, with the latter most commonly characterized by a muted inflammatory response at the ocular surface, meibomian gland dysfunction, and conceivably phenotypic changes in corneal epithelial cells. There is an expanding role for metabolic, hormonal, physical, neural and cellular stresses, including hyperosmolarity, mitochondrial stress, and neurogenic inflammation. Advancements in tear film research recommend new approaches to understanding DED pathogenesis and identifying biomarkers, such as microRNAs. Ocular pain perception is linked to structural integrity of corneal nerves, functional capacities of neurons, and activity of the central and peripheral nervous systems. Iatrogenic DED can result from medications, contact lenses, and surgical procedures. Clinical trials now emphasize aligning design and end points with DED subtypes and therapeutic mechanisms, with new therapeutics and trial designs under consideration.

PubMed Disclaimer

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- ClinicalKey
- Elsevier Science
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

TFOS DEWS III: Digest

Affiliations

TFOS DEWS III: Digest

Authors

Affiliations

Abstract

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical