Clinical ophthalmology
The Evolving Landscape of Dry Eye Disease Risk Factors: A Comparative Analysis of the TFOS DEWS II (2017) and DEWS III (2025) Reports
By Reza A. Badian.
Abstract
Objective
To systematically compare the classification of risk factors for dry eye disease (DED) between the Tear Film and Ocular Surface Society (TFOS) International Dry Eye Workshop (DEWS) II (2017) and DEWS III (2025) reports, highlighting changes in the level of evidence certainty, modifiability status, and clinical implications.
Methods
The TFOS DEWS II Epidemiology Report and the TFOS DEWS III reports were analyzed. Risk-factor classifications were extracted and compared along two axes: evidence certainty (consistent, probable, inconclusive) and modifiability (non-modifiable, modifiable). Key changes were identified, grouped into categories that included upgrades, downgrades, and reclassifications, and then reorganized and transformed into a practical table format based on the level of evidence certainty.
