Use the latest Tear Film & Ocular Surface Society Report in practice

Recently, the Tear Film & Ocular Surface Society (TFOS) released the global workshop report: “TFOS lifestyle: Impact of societal challenges on the ocular surface.”¹

Here, I provide the highlights of this 35-page report, along with related takeaways.

Occupational hazards

Specific occupations that ex-pose employees to chemicals, corrosives, or excessive heat could result in acute or chronic ocular surface injury. Also, jobs with environmental factors, such as sunlight and air pollution, increase the risk of ocular surface disease (OSD), pterygiums, pingueculas, and the early development of cataracts.

Something else to consider: Unemployment and retirement have been linked to health problems, including DED.

Takeaway. Ask about what a patient’s job entails to assess their risk for DED, as well as possible treatments.

Food findings

Food insecurity and nutritional deficiencies are known to have negative consequences on ocular surface health and risk for DED. Food insecurity is worsening due to climate change, immigration, poverty, and COVID-19. This exacerbation is compounded by a difficulty in access to affordable services, including eye care.

What’s more, anorexia nervosa in young females has increased over the last two decades and spiked during the COVID-19 pandemic. Eating disorders have been associated with a 1.6 x increased prevalence of DED, likely related, in part, to significant vitamin deficiencies. Also, obesity, linked with decreased tear break-up time (TBUT), meibomian gland dysfunction (MGD), and higher DED risk overall, continues to rise.

Takeaway. When noting a patient has DED or MGD, ask about diet to see whether a diet change may help.

The price of a vice

Alcohol use can lead to a TBUT decrease, increased tear osmolarity, and increased corneal staining. It may also increase corneal inflammatory cytokines.

Meanwhile, e-cigarettes and vape pens significantly reduce tear film stability and lead to an increase in ocular surface staining and ocular irritation. This is believed to also cause changes in conjunctiva cytology, decrease sensitivity in both the cornea and conjunctiva, increased tear osmolarity, and eyelid margin abnormalities.

Takeaway. Ask patients about their use of alcohol and tobacco. Is it excessive? If so, educate patients about this.

COVID-19 consequences

TFOS found four broad areas associated with the impact of the COVID-19 pandemic that were implicated in worsening DED:

1. Increased digital device use and screen time.
2. Face masks and other personal protective equipment.
3. COVID-19 infection on frequency and severity of OSD.
4. COVID-19 pandemic-related public health measures (i.e., social distancing, vaccination) and hy-giene practices (hand sanitizer) on ocular surface disease.

All four led to increased chalazia, decreased tear film stability, ocular dryness, contact lens intolerance, eye strain, ocular surface burns with toxic keratopathy from hand sanitizer, and irradiation-induced photokeratitis from UV germicidal lamps.

Takeaway. Ask patients about their history of the virus, as well as changes in life since the pandemic. Then, prescribe adjustments to environmental factors that can be controlled. OM

Reference

1. Stapleton F, Abad JC, Barabino S, et al. TFOS lifestyle: Impact of societal challenges on the ocular surface. Ocul Surf. 2023; 28:165-199. doi: 10.1016/j.jtos.2023.04.006.

DR. KOETTING is a clinical instructor at the University of Colorado School of Medicine. She is a fellow of the American Academy of Optometry, diplomate of the American Board of Optometry, an active AOA member, and she consults for multiple companies. Email her at Dr.CeceliaKoetting@gmail.com.