When editors see a word or phrase so overused that it has become a cliché, we instinctively reach for the red pen. We prefer language that’s fresh and original, free from the baggage of prior associations. And, ideally, our writing should be as simple as possible. My colleagues on the Review editorial staff know all too well of my distaste for the word utilize, which has a whiff of pretension to it. To my mind, use is less fussy while saying exactly the same thing.
But some odd ducks find a home within a given community. In medical circles, one of the oddest ducks is armamentarium, used to describe the array of treatment options at a doctor’s disposal. Why this vaguely Medieval six-syllable word persists in medical discourse is a mystery. But doctors seem to love it. We at Review let it slip into these pages regularly. (An archive search finds more instances than I care to admit.)
Another word popular in medicine is paradigm, to describe the general framework of how experts think or act about something. The related phrase paradigm shift marks a point in time when the experts agree that radical change has come to their field—that the profession has suddenly moved forward as one.
While it’s a handy way to convey a complex concept, paradigm has been a cliché for decades. Corporate types diluted it through overuse, especially by attaching it to ho-hum projects that didn’t warrant such a potent word, dressing up their language in formal wear when business casual would do. There’s even a Dilbert cartoon from as far back as 1991 parodying this overreach.
So when I say that a paradigm shift has just occurred in dry eye, I don’t do so lightly. But the publication of the Dry Eye Workshop (DEWS) II from the Tear Film and Ocular Surface Society (TFOS) brings so much clarity to the opaque world of ocular surface disease that it’s sure to be seen as just such a turning point for at least the next decade (assuming TFOS has a DEWS III planned for 2027).
DEWS II does away with the artificial distinction between evaporative and aqueous deficient dry eye, stressing that the two appear together far more than previously believed. Similarly, it replaces the familiar three-layer concept of the tear film with a “two-phase” model in which all components, not just the lipids, play a role in evaporation. It updates the definition of dry eye to emphasize the concept of homeostasis, by noting its absence, and establishes its restoration as the goal of therapy. It describes the cyclical, self-perpetuating nature of the pathophysiology and brings to the forefront the role of hyperosmolarity. It provides a systematic approach to diagnosis and proposes a classification scheme driven by the role of symptoms. And it grounds all that in a rigorous scientific method that had been sorely lacking.
This issue of Review of Optometry includes a special report on the TFOS DEWS II paradigm shift. In it, I’m sure you’ll find many new ideas you can utilize to strengthen your armamentarium. Enjoy!