Vital insights from the DEWS III report
If you regularly treat dry eye patients, you’re likely familiar with the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) reports. Since the first rendition was published in 2007,1 these reports have comprehensively studied all peer-reviewed, evidence-based publications regarding the disease itself and a broad spectrum of treatment modalities and their efficacies for management of dry eye disease. With DEWS III having been recently published, Joseph Tauber, MD, Chief Medical Officer of Vital Tears and co-author of the report’s ‘Management and Therapy’ section, takes us through the latest insights.
Top line news on DEWS
One big change in the DEWS III report compared to its predecessor (the 2017 TFOS DEWS II Report) is how dry eye disease is defined (with ocular symptoms now required for diagnosis) and classified. The updated classification identifies nine autonomous etiological drivers—the lipid, aqueous, and mucin tear film layers, alongside eyelid anatomical juxtaposition, blinking, lid margin, nerves/sensation. cellular damage, and inflammation/oxidative stress. These nine drivers can then be grouped into subcategories by anatomic division (tear film, eyelids, and ocular surface) or pathophysiologic pathways (tear insufficiency, corneal epithelial damage, ocular surface inflammation, and neural dysfunction).
Because these drivers are both autonomous and can affect individual patients at differing severities, one patient’s experience of dry eye disease can completely differ from another’s, increasing the complexity of staging dry eye. “You can have a patient with lots of inflammation but little cellular damage (corneal staining) and another with minimal inflammation but lots of cell damage, and both with symptoms,” Dr. Tauber explains. “It is virtually impossible to classify each as simply “mild or severe”.
How does this updated understanding affect treatment? “You have to treat everything that’s active, each driver contributing to symptoms or to signs," highlights Dr. Tauber. A metaphor he uses to explain this to patients is that of a car with flat tires and an empty gas tank—if you refuel without inflating the tires—or vice versa—you still can’t drive your car. You have to fix all that is wrong. “That’s the central lesson of DEWS III: you can’t leave one driver untreated and hope to effectively treat your patient,” he says. “Comprehensive, individualized treatment works, while a stepwise escalation of therapies (start with A then add B if insufficient, etc.) rarely succeeds.”
Once all contributing drivers in a given patient are identified, there’s still the question of how exactly to intervene and what specific treatments to choose. Although Dr. Tauber encourages clinicians to read the entire DEWS III report, he highlights the last few pages, which contain summarizing figures. Here, practitioners can see the deficiencies that occur in each anatomical category, the pathophysiologic drivers at play, the location in the report where a full review of the evidence can be found, categories of potential interventions, and the strength of the evidence supporting each treatment.
Super-serum tears
When it comes to therapeutics, the dream is a single-treatment solution capable of addressing everything at once. Although life is rarely that simple, Dr. Tauber notes that there was one treatment in the DEWS III report that stood out compared to everything else: serum tears. “Considering the different drivers potentially needing to be addressed in a dry eye patient, serum tears actually tackle all of them,” highlights Dr. Tauber. “Serum tears address tear insufficiency, improving both tear quantity and quality, and make an impact on corneal staining, promoting healing and maintenance of a healthy surface. Because it contains a litany of growth factors and regenerative components, serum also addresses neural dysfunction—something few other interventions can do—and, both directly and indirectly, quells inflammation.”
But, if it’s really this powerful, why haven't serum tears dominated the landscape of first-line dry eye treatments to date? The answer may reflect how the DEWS reports are written and published. Each report collates evidence from the publication date of its predecessor to its own, meaning that widespread knowledge regarding cutting-edge dry eye modalities may remain limited until the next edition is released. In 2017—when DEWS II was published—although there were glimpses of serum tears’ potential, but systematic reviews at the time noted that, alongside the lack of an established standardized method of preparation, there weren’t enough large, high-quality, randomized controlled trials to recommend serum tears with certainty.2
With the publication of DEWS III, Dr. Tauber explains that there are now several high-quality studies demonstrating that serum tears improves signs and symptoms in dry eye patients, having superior results compared to both cyclosporine, when analyzing ocular surface disease index (OSDI),3 and artificial tears.4,5 Additionally, multiple preferred practice guidelines, including those published by the American Academy of Ophthalmology,6 EULAR,7 and the Indian Journal of Ophthalmology,8 all now include the use of serum tears.
And more data is coming. The results of a yet-to-be-published study by Vital Tears, a national distributor of serum tears, which evaluated data from over 1000 patients, found that over 79% reported symptom improvement after 30 days of serum tear use. When looking at OSDI gain, 59.3% experienced a clinically meaningful change (greater than a 15-point gain). The researchers also had to define a new category, significant OSDI improvement, to account for the 29.8% of patients in whom there was a greater than 25-point OSDI gain—with this group expanding to encapsulate 31.6% of long-term patients. It’s no wonder then that over three-quarters of all patients elected to persist with serum tear use, even after a median of 300 days.
Tears without fears
“Serum tears’ broad mechanism of action really aligns with everything that we now understand about dry eye in 2025 and the DEWS III framework of an individualized, mechanism-directed treatment approach,” notes Dr. Tauber. “There’s a fast onset of benefit and higher adherence compared to other Rx drugs. Alongside this, serum tears are incredibly cost-effective compared to pharmaceutical agents, especially for Medicare-insured patients for whom commercial discounting isn’t available.”
But as always, great results are only great if patients can actually receive them in practice. Although historically, prescribing serum tears—and ensuring patients are receiving a standardized preparation of product, formulated under the appropriate sterile conditions—hasn’t always been simple, Vital Tears has worked to make this revolutionary dry eye treatment accessible to all. “There’s an e-prescribing portal through which a clinician can place an order specifying the frequency of use and dilution they want a patient to receive; then Vital Tears takes it from there,” explains Dr. Tauber.
Once the prescription has been submitted, Vital Tears takes care of the finances and contacts the patient to schedule a blood draw. The tears are processed in-house, validated through safety procedures, and then shipped directly to the patient within 48 hours of the blood draw. “It doesn't get much easier than that,” Dr. Tauber says. “I really feel that serum tears are something you ought to try. Your patients will be happy—and, when your patients are happy, you’ll be happy.”
