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. 2024 Jan 1;142(1):58-74.
doi: 10.1001/jamaophthalmol.2023.5751.

Interventions for Dry Eye: An Overview of Systematic Reviews

Paul McCann  1 , Zanna Kruoch  2 , Sarah Lopez  3 , Shreya Malli  4 , Riaz Qureshi  1   5 , Tianjing Li  1   5
Affiliations

Interventions for Dry Eye: An Overview of Systematic Reviews

Paul McCann et al. JAMA Ophthalmol. .

Abstract

Importance: Dry eye is a common ocular disease that can have substantial morbidity. Systematic reviews provide evidence for dry eye interventions and can be useful for patients, clinicians, and clinical guideline developers. Overviews of reviews use explicit and systematic methods to synthesize findings from multiple systematic reviews, but currently, there are no overviews of systematic reviews investigating interventions for dry eye.

Objective: To summarize the results of reliable systematic reviews of dry eye interventions and to highlight the evidence gaps identified.

Evidence review: We searched the Cochrane Eyes and Vision US satellite database and included reliable systematic reviews evaluating dry eye interventions published from 2016 to 2022. We reported the proportion of systematic reviews that were reliable with reasons for unreliability. Critical and important outcomes from reliable systematic reviews were extracted and verified. Critical outcomes included dry eye-related patient-reported outcome measures. Results were synthesized from reliable systematic reviews to provide summaries of evidence for each intervention. Evidence for each intervention was defined as conclusive or inconclusive depending on whether high-certainty evidence across systematic reviews was available according to Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria and whether findings reached statistical or clinical significance. Recommendations were made for further research.

Findings: Within the Cochrane Eyes and Vision US satellite database, 138 potentially relevant systematic reviews were identified, 71 were considered eligible, and 26 (37%) were assessed as reliable. Among reliable systematic reviews, no conclusive evidence was identified for any dry eye intervention. Inconclusive evidence suggested that environmental modifications, dietary modifications, artificial tears and lubricants, punctal occlusion, intense pulsed light therapy, vectored thermal pulsation therapy (Lipiflow), topical corticosteroids, topical cyclosporine A, topical secretagogues, and autologous serum may be effective. Only unreliable systematic reviews evaluated lifitegrast, oral antibiotics, and moisture chamber devices.

Conclusions and relevance: This overview of systematic reviews found some evidence that dry eye interventions may be effective, but no conclusive evidence was available. The conduct and reporting of most systematic reviews for dry eye interventions warrant improvement, and reliable systematic reviews are needed to evaluate lifitegrast, oral antibiotics, and moisture chamber devices.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr McCann reported being affiliated with Cochrane Eyes and Vision US satellite during the course of this study. Dr Kruoch reported receiving a speaker honorarium from Triad Ophthalmics outside the submitted work. Dr Qureshi reported being affiliated with Cochrane Eyes and Vision US satellite during the course of this study. Dr Li reported being affiliated with Cochrane Eyes and Vision US satellite during the course of this study. No other disclosures were reported.

Comment in

  • The Problem With Dry Eye Trials.
    Galor A, Margolis TP, Britten-Jones AC. Galor A, et al. JAMA Ophthalmol. 2024 Jan 1;142(1):74-75. doi: 10.1001/jamaophthalmol.2023.5991. JAMA Ophthalmol. 2024. PMID: 38127363 No abstract available.

References

    1. Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276–283. doi:10.1016/j.jtos.2017.05.008 - DOI - PubMed
    1. Miljanović B, Dana R, Sullivan DA, Schaumberg DA. Impact of dry eye syndrome on vision-related quality of life. Am J Ophthalmol. 2007;143(3):409–415. doi:10.1016/j.ajo.2006.11.060 - DOI - PMC - PubMed
    1. Yu J, Asche CV, Fairchild CJ. The economic burden of dry eye disease in the United States: a decision tree analysis. Cornea. 2011;30(4):379–387. doi:10.1097/ICO.0b013e3181f7f363 - DOI - PubMed
    1. Akpek EK, Amescua G, Farid M, et al.; American Academy of Ophthalmology Preferred Practice Pattern Cornea and External Disease Panel. Dry Eye Syndrome Preferred Practice Pattern®. Ophthalmology. 2019;126(1):286–P334. doi:10.1016/j.ophtha.2018.10.023 - DOI - PubMed
    1. Jones L, Downie LE, Korb D, et al. TFOS DEWS II management and therapy report. Ocul Surf. 2017;15 (3):575–628. https://www.sciencedirect.com/science/article/pii/S1542012417301143. doi:10.1016/j.jtos.2017.05.006 - DOI - PubMed

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