Gaps in Current Knowledge and Priorities for Future Research in Dry Eye

Abstract

Purpose: Dry eye, a common yet underrecognized and evolving field, has few recommended treatment algorithms, mostly based on expert consensus rather than robust research evidence. There are high costs associated with managing dry eye and conducting research to identify effective and safe long-term treatments. To support evidence-based management of dry eye, our purpose was to identify and prioritize important clinical research questions for future clinical research.

Methods: We translated recommendations from the American Academy of Ophthalmology's 2013 Preferred Practice Patterns for dry eye into answerable clinical research questions about treatment effectiveness. Clinicians around the world who manage patients with dry eye rated each question's importance from 0 (not important) to 10 (very important) using a 2-round online Delphi survey. We considered questions as "important" if ≥75% of respondents assigned a rating of 6 or more in round 2. We mapped the identified important clinical research questions to reliable systematic reviews published up to March 2016.

Results: Seventy-five clinicians from at least 21 countries completed both Delphi rounds. Among the 58 questions, 24 met our definition of "important": 9/24 and 7/24 addressed topical and systemic treatments, respectively. All 4 questions with the highest 25th percentiles addressed topical treatments. Although 6/24 "important" questions were associated with 4 existing reliable systematic reviews, none of these reviews came to a definitive conclusion about treatment effectiveness.

Conclusions: We identified gaps pertaining to treatment options for dry eye. Future clinical research on the management of dry eye should strongly consider these prioritized questions.

Figure 1. Box and whiskers plot displaying the ratings assigned to 58 dry eye clinical research questions by 75 Tear Film and Ocular Surface Society (TFOS) member respondents to Round 2 of our Delphi survey, sorted in decreasing order of the 25^th percentile

1. - Y-axis – Ratings of importance assigned in Round 2 of the Delphi survey.

2. - X-axis – Question numbers, sorted from left to right in decreasing order of the 25^th percentile of the rating assigned.

3. - Boxes – These correspond to the interquartile range (i.e., 25^th to 75^th percentile) of the rating assigned to each question in Round 2.

4. - Colors of the boxes –

   1. ○ Blue: At least 75% of respondents assigned a rating of 6 or higher (i.e., “important” questions)

   2. ○ Yellow: At least 75% of respondents assigned a rating of 5 or higher (i.e., “moderately important” questions)

   3. ○ Grey: Fewer than 75% of respondents assigned a rating of 5 or higher

5. - Whiskers – These correspond to the range (i.e., minimum to maximum) of ratings assigned to each question in Round 2.