Worried About Electromagnetic Radiation?

HOT TOPIC

TFOS DEWS III: The Full Report Is Out!

The news is out: the Tear Film & Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) III is now available! Significant Findings was one of the first outlets to cover it, albeit lightly, in last week’s newsletter. (I was waiting to see if any more reports would be released.) After a formal announcement by TFOS, we can now dive into the report. The TFOS DEWS III Digest Report is a comprehensive document accompanied by multiple other reports that provide specialized investigations.

I received numerous texts and emails about the report last week, asking for clarification on several points, particularly regarding the Ocular Surface Disease Index-6 (OSD-6), a shortened, six-question version of the original OSDI questionnaire that DEWS III recommends we all adopt. Kudos to TFOS for encouraging us all to get on the same page with one incredibly assembled patient survey.

The TFOS DEWS committee says, “The OSDI-6 is a short questionnaire, ideal for screening, and is recommended to be conducted as the first component within routine eye examinations to identify those patients who would benefit from a fuller diagnostic evaluation to determine the likely drivers of disease.” It explicitly asks patients about light sensitivity, blurred vision, difficulty functioning or driving at night, screen or technology use, and discomfort from windy conditions.

In a nutshell, the committee recommends that once you administer and grade the OSD-6, you should (obviously) move into the clinical evaluation of the patient’s ocular surface. The DEWS III information is the meat of the report and is best read individually or by attending a CE event about it. Essentially, the report recommends tear meniscus and/or osmolarity testing, as well as noninvasive tear break-up time (NIBUT) evaluation. The committee goes on to specify that “further research has shown that using NIBUT or osmolarity has a similar impact on the number of people diagnosed with dry eye disease, whereas assessing ocular surface staining (including corneal fluorescein staining and lissamine green staining of the bulbar conjunctiva and lid margin) must be included.”

While assessing ocular surface staining patterns, if more than five punctate spots are found on a patient’s cornea, and/or nine punctate spots are found on the conjunctiva, and/or lid margin staining of 2 mm or more in length and 25% of the width of the lid is present, they have dry eye.

In summary, according to the new TFOS DEWS III Diagnostic Algorithm:

• Administer the OSD-6 questionnaire to the patient (a score of 3 or above indicates dry eye).
• Perform either a tear film osmolarity test (a score of 308 or higher indicates dry eye or difference between the eyes) or a NIBUT test (any time < 10 seconds indicates dry eye). You could always perform both osmolarity and NIBUT.
• Look at the ocular surface.
  • Are five or more punctate spots visible on the cornea?
  • Are nine or more punctate spots present on the conjunctiva?
  • Is there staining on the lid margin 2 mm in length or more and 25% of the lid width?

OUTSIDE THE LANE

A Contact Lens to Protect Against Electromagnetic Radiation?

Under the guidance of Takeo Miyake, PhD, researchers from the Graduate School of Information Production and Systems at Waseda University in Japan have developed a groundbreaking MXene-coated contact lens that could significantly enhance future eye health and safety, particularly for eye care professionals working with patients exposed to electromagnetic radiation (EMR) from smart devices.

This innovation, published in Small Science, addresses rising worries about EMR exposure associated with smart contact lenses, which could lead to cataracts and other eye-related issues. (As a reminder, smart contact lenses are devices being developed to monitor health information such as blood sugar levels.) The lenses from Waseda University incorporate MXene, a 2D transition metal carbide/nitride recognized for its EMR-shielding capabilities. Employing a novel wet-transfer fabrication technique using acetone, the researchers achieved stable adhesion of MXene nanosheets to commercial soft contact lenses, preventing oxidation and ensuring scalability. As a result, the lenses boast more than 80% visible light transmission, high conductivity, and remarkable biocompatibility, with cell viability greater than 90%. Moreover, the lenses retain moisture, which enhances comfort for users and will hopefully reduce the risk of dry eye. A partnership with Kyoto University and Yamaguchi University Hospital brought together expertise in nanofabrication, 2D materials, and eye care, ensuring the lenses adhere to clinical safety standards. For optometrists, these lenses offer an exciting solution for patients who use smart wearables, protecting against high-frequency radiation while maintaining optical clarity and comfort. This technology also paves the way for the integration of advanced nanomaterials into therapeutic contact lenses, potentially transforming treatment methods for issues such as myopia or presbyopia. In addition to its implications for eye health, this innovation could affect bioelectronics and medical implants, meeting the rising demand for safer wearable technologies.

My Two Cents

I’m still not totally on board with the exposure from cell phones, computers, etc, causing harmful levels of EMR to myself, my family, or patients; however, I’m certainly glad others are looking into it. Also, as someone who fits a lot of scleral lenses, it is exciting to see that the entire concept of putting microchips and advanced technology that close to the eye is under investigation. With blood glucose monitoring contact lenses continuing to be developed, along with undoubtedly other advanced technologies, it’s encouraging to see there are things that could potentially be added to the lenses to keep the eye as safe as possible. Neat stuff!

CAN YOU RELATE

Last weekend, I was fortunate enough to team up with the legendary Paul Karpecki, OD, FAAO, and one of our profession’s brightest stars, Jackie Garlich, OD, FAAO, to deliver a full-day ocular surface lecture series to an incredible group of doctors in Chicago. The entire day consisted of nearly 10 hours of talks, breakout sessions, and hallway discussions, which are sometimes the best part of conversations and where most of the real action occurs.

Dr. Karpecki orchestrated the entire day along with the presentations. I’ve never attended a CE event where the same doctors were on stage on the same day. My conference schedule is typically a hodgepodge of sessions on various topics that interest me or by speakers I know and want to hear from. This particular conference was so excellent in that everything had a set order and place. There was no redundancy, even though dry eye was the primary focus. Kudos to Dr. Karpecki and the event organizers for a well thought out and planned event! It was undoubtedly an incredible day of discussion on the ocular surface and dry eye. Suffice it to say that things are changing in eye care in every facet. From private equity and practice management to the transition to interventional MIGS procedures in glaucoma care (to be discussed at a later date), myopia management, and the rise of sketchy online companies, change is everywhere, including in dry eye care. There is no time like the present to be active in your profession and do your best to stay ahead of the curve. That’s why in-person conferences are so valuable for everyone. By attending conferences such as Optometry’s Meeting, Academy, MOD Live, and the Ocular Surface Symposium, you can get debriefed on much of what is occurring without breaking a sweat and while earning that mandatory CE from world-class speakers, visiting exhibit halls to learn what’s new, and reconnecting with both old and new friends.

QUOTE OF THE WEEK

“The eye, which is called the window of the soul, is the principal means by which the central sense can most completely and abundantly appreciate the infinite works of nature.”

— Leonardo da Vinci