Middle East Preferred Practice Patterns for Dry Eye Disease: A Modified Delphi Consensus

Abstract

Background: Dry Eye Disease (DED) is a common ophthalmic condition resulting from dysfunction in the ocular surface, main lacrimal gland, meibomian glands, or connecting nerves. Objective: A group of local experts met to discuss local challenges and establish consensus in DED management across the Middle East. Methods: A modified Delphi method was used to reach consensus, comprising two rounds of the survey and a face-to-face meeting. An expert panel of 8 ophthalmologists voted on 23 statements, with consensus reached if ≥75% responded “strongly agree” or “agree” to a statement. Results: The expert panel reached consensus on 23 statements relating to the pathophysiology, diagnosis, treatment, and management of DED. Diagnosis begins with recording a detailed patient history and assessing subjective symptoms such as redness, burning, stinging, foreign body sensation, and/or photophobia. Tear Break-up Time (TBUT; <10 s), corneal spots (>5), and fluorescein staining are essential for diagnosing DED, assessing disease severity and ocular surface condition, and differentiating between types of DED. Ocular surface lubricants are the mainstay of treatment for DED. Treatment approaches should be categorized by etiology (if known). An improvement in symptoms can be observed objectively via an increase in TBUT, reduction in corneal and conjunctival spots, and restoration of normal tear production, or subjectively via less dependence on ocular surface lubricants, improved vision quality, and symptom amelioration. Conclusion: This consensus will serve to provide a framework for clinical decisions relating to the management of DED across the region.

Effect of aerobic exercise alone or combined with Mediterranean diet on dry eye in obese hypertensive elderly

“…Depression can be evoked in DE patients due to their poor quality of life (QoL). Daily activities dependent on vision are affected by DE disorder such as writing, reading, television watching, computer mobile use, and driving, so QoL is affected [ 3 ].…”

Prevalence and Behavioral-Based Risk Factors (Eye Cosmetic and Tobacco Use) of Symptomatic Dry Eye Disease in Four Middle Eastern Countries: Lebanon, Syria, Jordan, and Palestine

“…In agreement with the literature on DED prevalence among the Arab population, the average estimation of DED prevalence is relatively high (70.2%) with high ranging percentages (65.2-73.4%) among the studied countries. 4,26 The high prevalence in the Arab countries could be associated with the high prevalence of rheumatoid arthritis, diabetes mellitus, and the heavy use of age-related systemic and topical medications in elderly people. 4 Additionally, the population of the Middle Eastern countries is identified with poor education concerning DED, irregular follow-up, high proportions of contact lens use along with some environmental factors (eg, heavy use of air conditions, hot weather, excessive use of electronic devices, fine particulate pollution, and corrosive air salts due to proximity of countries to the sea).…”

“…4 Additionally, the population of the Middle Eastern countries is identified with poor education concerning DED, irregular follow-up, high proportions of contact lens use along with some environmental factors (eg, heavy use of air conditions, hot weather, excessive use of electronic devices, fine particulate pollution, and corrosive air salts due to proximity of countries to the sea). 26 As being Middle Eastern countries (also Arab) with similar climate features, Lebanon, Syria, Jordan, and Palestine were chosen for this study to minimize the interference of environmental risk factors in the study findings. 27…”

Dry Eye Disease in the Middle East and Northern Africa: A Position Paper on the Current State and Unmet Needs

“…However, other factors may influence the selection of treatment, such as access to reimbursement, cost of treatment, patient adherence, socioeconomic status, distance from the treatment center, and age. 89 DED management and treatment recommendations should be done in stages, but therapies must be tailored to individual patient profiles and needs. 90…”