New Insights into Dry Eye Disease: Demographics and Systemic Factors

In a groundbreaking report released in June 2025, the Tear Film and Ocular Surface Society (TFOS) has illuminated critical demographic and systemic health factors associated with Dry Eye Disease (DED). The comprehensive 'TFOS DEWS III Digest Report,' published in the *American Journal of Ophthalmology*, synthesizes findings from over 80 experts across 18 countries, aiming to expand upon the foundational work established in the 2017 TFOS DEWS II Workshop reports.

The report reveals that DED prevalence is significantly higher in women compared to men, with age being a critical factor in disease manifestation. According to Dr. Fiona Stapleton, PhD, MSc, a leading researcher from the School of Optometry and Vision Science at UNSW Sydney, the report identifies essential advancements in understanding the pathophysiology of DED, which includes distinguishing between aqueous deficient dry eye (ADDE) and evaporative dry eye (EDE).

“Significant research advances have linked sex, hormones, and gender to DED, while the effects of aging, cancer, and hormone therapy further complicate the landscape,” stated Dr. Stapleton during a press briefing on the report. The report emphasizes the need for more nuanced research into how gender-affirming hormone therapies impact ocular health, highlighting a gap in existing literature despite the therapies' widespread use.

From an epidemiological perspective, the report notes a troubling trend: DED symptoms are increasingly prevalent among younger populations, particularly women. “There is a pressing need for appropriately powered studies focusing on individuals under 40 to better understand the risk factors and prevalence of DED among this demographic,” remarked Dr. Sandra Lee, an ophthalmologist at Johns Hopkins University, who was not involved in the study but has closely followed the developments in DED research.

The report also calls for greater exploration into the relationship between lipid composition in tear films and DED, a potentially transformative area of research. “Understanding the differences between disordered lipids that exacerbate evaporation versus ordered lipids that enhance resistance to evaporation could significantly advance our treatment approaches,” noted Dr. Argüeso, a prominent researcher in ocular surface disease.

The authors pointed out the necessity of investigating the microbiome and its potential role in DED pathogenesis across diverse ethnic groups and geographic regions. “Analyses of microbial changes could give us critical insights into DED and its markers,” they concluded.

Furthermore, the report provides recommendations for managing DED, particularly in relation to iatrogenic factors linked to various medications, including anti-glaucoma drugs and hormone replacement therapy. “Identifying the specific medication contributing to DED can be challenging, especially when multiple treatments are involved,” warned Dr. Asbell, a senior researcher at the University of Illinois College of Medicine, who emphasized the importance of careful patient monitoring and tailored treatment protocols.

The implications of the TFOS DEWS III Digest Report are profound for both the clinical management of DED and future research directions. As the field continues to evolve, the call for interdisciplinary collaboration among healthcare professionals, researchers, and patients is more critical than ever. The report not only sheds light on existing knowledge gaps but also paves the way for future investigations into the complex interplay of demographic factors and systemic health that underlie Dry Eye Disease.