Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Optics and Spectroscopy, Faculty of Physics, St. Kliment Ohridski University of Sofia, Sofia, Bulgaria.
Invest Ophthalmol Vis Sci. 2018 Nov 1;59(14):DES13-DES22. doi: 10.1167/iovs.17-23700.
In December 2010 and January 2012, 3% diquafosol sodium ophthalmic solution and 2% rebamipide ophthalmic suspension, respectively, appeared first in Japan as prescription drugs for the treatment of dry eye (DE). Since then, not only the diagnosis and treatment but also the understanding of the pathophysiology of DE have greatly advanced, and a new concept of layer-by-layer diagnosis and treatment for DE, respectively termed "tear-film-oriented diagnosis" (TFOD) and "tear-film-oriented therapy" (TFOT) was born. This new concept is currently in the process of expanding from Japan to other Asian countries. TFOD is the method used for the differential diagnosis of DE, which includes aqueous-deficiency DE (ADDE), decreased wettability DE (DWDE), and increased evaporation DE (IEDE), through the dynamics of tear film (TF) and breakup patterns (BUPs) after the eye is opened. BUPs and/or each diagnosed DE subtype are/is able to distinguish the insufficient components of the ocular surface that are responsible for each BUP in a layer-by-layer fashion. Aqueous fluid, membrane-associated mucins (especially MUC16), and the lipid layer and/or secretory mucins must be insufficient in ADDE, DWDE, and IEDE, respectively, and this allows for a layer-by-layer treatment to be proposed for each BUP via the supplementation of the insufficient components, using the topical therapy currently available. In Japan, TF breakup is regarded as a visible core mechanism for DE, and an abnormal breakup time (i.e., ≤5 seconds) and symptoms are currently used for the diagnosis of DE. Therefore, TFOD and TFOT could be an ideal and practical pathway for clinicians to manage DE.
2010 年 12 月和 2012 年 1 月，3%地夸磷索钠滴眼液和 2%瑞巴派特滴眼液分别在日本首次作为治疗干眼症 (DE) 的处方药上市。此后，不仅是 DE 的诊断和治疗，而且对其病理生理学的理解也取得了很大进展，一种新的 DE 分层诊断和治疗的概念分别被命名为“泪膜导向诊断”（TFOD）和“泪膜导向治疗”（TFOT）。这一新概念目前正从日本向其他亚洲国家扩展。TFOD 是用于 DE 鉴别诊断的方法，通过泪膜（TF）的动力学和泪膜破裂模式（BUP），将 DE 分为水液缺乏型（ADDE）、泪液黏附力降低型（DWDE）和泪液蒸发过强型（IEDE）。BUP 和/或每个诊断的 DE 亚型能够分层式地识别出负责每个 BUP 的眼表不足成分。在 ADDE、DWDE 和 IEDE 中，必须分别存在眼表水液、膜相关黏蛋白（尤其是 MUC16）和脂质层及/或分泌型黏蛋白不足，这使得可以通过局部治疗补充每个 BUP 中不足的成分，提出分层式治疗方法。在日本，泪膜破裂被视为 DE 的一个可见核心机制，异常的破裂时间（即≤5 秒）和症状目前用于 DE 的诊断。因此，TFOD 和 TFOT 可能是临床医生管理 DE 的一种理想且实用的途径。
