A short decade ago, the concept of dry eye was almost exclusively thought of in terms of tear deficiency. Since then the definition has ex­panded to describe an in­creasing host of conditions, with proposed etiologies that include the inflammatory and even the neurogenic.

Here's a monumentally unscientific measure of how far ophthalmology has come in a short time: Just six years ago, there were fewer than 20 abstracts reported at ARVO under the heading of dry eye. This year there were nearly 220.

As is often the case, much of the early effort in this burgeoning area of research is still devoted to definitions and conformity. Seemingly simple is­sues (to outsiders) such as what to call dry eye, how to measure its im­pact on patients and how to diagnose it are still being debated, developed and refined. Consensus on treatment is years away at best.

As is also often the case, pro­gress in that period has come in fits and starts.

On one hand, clinicians are fortunate to have an approved medical treatment, Restasis, to offer dry-eye pa­tients. On the other, it's not cheap, and its most effective uses are still being developed. (See p. 42 for more on this.)

On one hand, this month comes news from the American Journal of Clin­ical Nutrition of a new tack in the war of dry eye. Among their findings, re­search­ers at Brigham and Women's Hos­pital and Schepens Eye Re­search In­stitute in Boston report that:

      • Women with the high­est dietary levels of omega 3 reduced their risk of dry-eye syndrome by 20 percent com­pared to women with the lowest levels of this fat in their diet.

     •Women who re­ported eating at least five servings of tuna per week had a 68-percent reduced risk of dry-eye syndrome compared to women who consumed one serving per week.

On the other hand, accurately distinguishing allergy from dry eye re­mains something of a diagnostic feat. (For help on this, see p. 35.)

The good news is that there"s no reason to think the pace of discovery in dry eye research in the next decade will not match, or even exceed, that of the past one.