title: Agreement of physician treatment practices with the international task force guidelines for diagnosis and treatment of dry eye disease.
abstract: OBJECTIVE
  To evaluate the clinical implementation of guidelines for the treatment of dysfunctional tear syndrome (DTS) developed by the International Task Force (ITF) of dry eye disease experts.
  
  
  METHODS
  Nine physicians implemented the ITF guidelines for 3 months. Newly diagnosed patients with DTS rated their ocular symptoms and were clinically examined. Using the guidelines, physicians determined the DTS severity level (0-4, where 4 is most severe) and made their therapeutic choices.
  
  
  RESULTS
  Of 183 patients enrolled (mean age, 65.1 years; range, 25-91 years), 67% presented without lid margin disease, and 68% had no apparent ocular surface inflammation. Symptoms were significantly more severe in patients with altered tear distribution or evident inflammation (P < 0.05). Most patients diagnosed at severity level 1 did not have lid margin disease (56/61, 92%), and inflammation was not apparent (53/58, 91%); 43% of severity level 1 patients (27/63) were treated at level 2 (therapeutic choices include unpreserved tears or topical cyclosporine). Most patients presenting with inflammation were diagnosed at severity level 2 (74%, 32/43). More than 9 in 10 severity level 2 patients were treated at level 2 (100/106; 94%). Physicians reported that 96% of their treatment recommendations were consistent with management they would have recommended if they had not consulted the ITF guidelines. They spent an average of 4.5 minutes per patient applying the guidelines.
  
  
  CONCLUSIONS
  Implementation of the ITF guidelines was simple and not time consuming. Many practitioners chose to treat patients diagnosed at severity level 1 with treatments at level 2 that include unpreserved tears and topical cyclosporine.
authors.affiliation: Cleveland Clinic Cole Eye Institute, Cleveland, OH, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wilson
authors.forename: R Doyle
authors.initials: RD
authors.lastname: Stulting
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003697:Delphi Technique; D015352:Dry Eye Syndromes / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012720:Severity of Illness Index