1
|
Lee DC, Guo M, Yu Y, Bunya VY, Asbell P, Ying GS. Two-Year Progression of Dry Eye Disease in Dry Eye Assessment and Management Study. Cornea 2024:00003226-990000000-00495. [PMID: 38391283 DOI: 10.1097/ico.0000000000003503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the progression of dry eye disease (DED) symptoms and signs over 2 years through a secondary analysis of data collected from the Dry Eye Assessment and Management study. METHODS Participants who were assigned to omega-3 fatty acid in the first year were rerandomized in the second year to either continue with omega-3 fatty acid or switch to placebo. At baseline, 3, 6, 12, 18, and 24 months, DED symptoms were evaluated by using the Ocular Surface Disease Index and the Brief Ocular Discomfort Index (BODI). DED signs were assessed using conjunctival staining, corneal staining, tear break-up time, Schirmer testing, and keratography measures. Medication usage was documented at each visit. Because the treatment and placebo groups displayed no statistical differences in both signs and symptoms, data from the 43 participants were combined to assess longitudinal changes in symptoms and signs. RESULTS At 3 months after omega-3 fatty acid treatment, there were significant improvements from baseline in Ocular Surface Disease Index and Brief Ocular Discomfort Index scores (all P ≤ 0.002) and less use of artificial tears or gel (P = 0.02), but between 3 and 24 months, no significant changes in symptoms and treatments were observed (P ≥ 0.06). Except for a significant improvement in conjunctival staining score over 2 years (P = 0.001), there were no significant sign changes in corneal staining (P = 0.32), tear break-up time (P = 0.43), Schirmer test (P = 0.09), and additional measures (all P ≥ 0.07). CONCLUSIONS We did not observe a progression of DED signs or symptoms over a 2-year period, except for a probable placebo response in symptoms in the first 3 months and an improvement in conjunctival staining score.
Collapse
Affiliation(s)
| | | | - Yinxi Yu
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA
| | - Vatinee Y Bunya
- Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; and
| | - Penny Asbell
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA
| | | |
Collapse
|
2
|
Seitzman GD, Lietman TM. Will the Long-Named Perfluorohexyloctane Produce Long-lasting Improvements in Patients With Meibomian Gland Disease? JAMA Ophthalmol 2023; 141:392-393. [PMID: 36928282 DOI: 10.1001/jamaophthalmol.2023.0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Gerami D Seitzman
- Francis I. Proctor Foundation, San Francisco, California.,Department of Ophthalmology, University of California, San Francisco
| | - Thomas M Lietman
- Francis I. Proctor Foundation, San Francisco, California.,Department of Ophthalmology, University of California, San Francisco
| |
Collapse
|
3
|
Li Z, Wang X, Li X. Effectiveness of Intranasal Tear Neurostimulation for Treatment of Dry Eye Disease: A Meta-Analysis. Ophthalmol Ther 2023; 12:389-400. [PMID: 36441506 PMCID: PMC9834483 DOI: 10.1007/s40123-022-00616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION To assess the effectiveness and safety of intranasal tear neurostimulation in the treatment of dry eye disease. METHODS We performed a meta-analysis of four databases from their inception to October 2022 without language restrictions. Randomized controlled trials and non-randomized controlled trials meeting the inclusion criteria were included in this review and were quality appraised. The risk of bias was evaluated by two independent reviewers using the Cochrane Collaboration Tool and Methodological Index for Non-Randomized Studies. The random-effect model or fixed-effect model was adopted to estimate the pooled effect sizes. RESULTS Fifteen published studies consisting of 17 clinical trials with a total of 901 patients were analyzed. Schirmer II test scores were significantly higher after intranasal tear neurostimulation in patients with dry eye disease (mean difference = 14.12 mm, 95% confidence intervals (8.93, 19.31), P < 0.001). Intranasal tear neurostimulation increased the meibomian gland areas (mean difference = - 251.79 μm2, 95% confidence intervals (- 348.34, - 155.23), P < 0.001), but no significant difference was found in meibomian gland perimeters before and after stimulation (mean difference = 3.72 mm, 95% confidence intervals (- 22.14, 29.59), P = 0.78). All adverse events were mild or moderate, and no serious adverse events were reported. CONCLUSIONS This meta-analysis provides promising evidence for the controversial effectiveness of intranasal tear neurostimulation in the treatment of dry eye disease, along with useful information for guiding intranasal tear neurostimulation in future clinical trials. TRIAL REGISTRATION This meta-analysis was registered on the Prospective Register of Systematic Reviews (PROSPERO) (CRD42021284214).
Collapse
Affiliation(s)
- Zihan Li
- Department of Ophthalmology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, China ,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Xinglin Wang
- Department of Ophthalmology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, China ,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, China ,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| |
Collapse
|
4
|
Placebo administration for dry eye disease: a level I evidence based systematic review and meta-analysis. Int J Clin Pharm 2022; 44:1087-1101. [PMID: 35939178 PMCID: PMC9618542 DOI: 10.1007/s11096-022-01439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 06/04/2022] [Indexed: 12/05/2022]
Abstract
Background The efficacy of various common treatment options for dry eye disease (DED) has been investigated against placebo. However, the potential beneficial effect of placebo in the management of DED is still unclear. Aim This meta-analysis investigated the impact of placebo administration in DED in Ocular Surface Disease Index (OSDI), Schirmer I test (SIT), tear breakup time (TBUT), corneal staining, and complications. Method This meta-analysis and systematic review was conducted according to the 2020 PRISMA guidelines. In March 2022, Pubmed, Web of Science, Google Scholar, and Embase were accessed. All the randomised clinical trials which investigated any active treatment against a placebo control group were considered. The following data were extracted at baseline and at last follow-up: Ocular Surface Disease Index (OSDI), tear breakup time test (TBUT), Schirmer I test (SIT), corneal staining. Results Data from 56 studies (12,205 patients) were retrieved. Placebo administration is not effective in improving TBUT (P = 0.3), OSDI (P = 0.2), SIT (P = 0.1) and corneal staining (P = 0.1) from baseline to last follow-up. Active treatment led to a higher TBUT and SIT compared to placebo administration (P < 0.0001). The active treatment resulted in a lower OSDI compared to placebo administration (P = 0.0005). Five studies reported data on the corneal staining. No difference was found between placebo administration and active treatment (P = 0.8). Conclusion Placebo administration does not impact symptoms of DED and can be successfully employed to evaluate the efficacy of active treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s11096-022-01439-y.
Collapse
|
5
|
McCann P, Kruoch Z, Qureshi R, Li T. Effectiveness of interventions for dry eye: a protocol for an overview of systematic reviews. BMJ Open 2022; 12:e058708. [PMID: 35672062 PMCID: PMC9174758 DOI: 10.1136/bmjopen-2021-058708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Dry eye is a leading cause of ocular morbidity and economic and societal burden for patients and healthcare systems. There are several treatment options available for dry eye and high-quality systematic reviews synthesise the evidence for their effectiveness and potential harms. METHODS AND ANALYSIS We will search the Cochrane Eyes and Vision US satellite (CEV@US) database of eyes and vision systematic reviews for systematic reviews on interventions for dry eye. CEV@US conducted an initial search of PubMed and Embase to populate the CEV@US database of eyes and vision systematic reviews in 2007, which was updated most recently in August 2021. We will search the database for systematic reviews published since 1 January 2016 because systematic reviews more than 5 years are unlikely to be up to date. We will consider Cochrane and non-Cochrane systematic reviews eligible for inclusion. Two authors will independently screen articles. We will include studies that evaluate interventions for dry eye and/or meibomian gland dysfunction with no restriction on types of participants or review language. We will select reliable systematic reviews (ie, those meeting pre-established methodological criteria) for inclusion, assessed by one investigator and verified by a second investigator. We will extract ratings of the certainty of evidence from within each review. We will report the degree of overlap for systematic reviews that answer similar questions and include overlapping primary studies. We will present results of the overview in alignment with guidelines in the Cochrane Handbook of Systematic Reviews of Interventions (Online Chapter 5: Overviews of Reviews), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and an overview of reviews quality and transparency checklist. The anticipated start and completion dates for this overview are 1 May 2021 and 30 April 2022, respectively. ETHICS AND DISSEMINATION This overview will not require the approval of an Ethics Committee because it will use published studies. We will publish results in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021279880.
Collapse
Affiliation(s)
- Paul McCann
- Department of Ophthalmology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Zanna Kruoch
- Cedar Springs Eye Clinic, College of Optometry, University of Houston, Houston, Texas, USA
| | - Riaz Qureshi
- Department of Ophthalmology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
6
|
Hirabayashi KJ, Akpek EK, Ahmad S. Outcome Measures to Assess Dry Eye Severity: A Review. Ocul Immunol Inflamm 2022; 30:282-289. [PMID: 35113753 DOI: 10.1080/09273948.2022.2027461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Outcome measures used to assess efficacy of dry eye therapeutics have not been consistently applied in clinical settings, nor have they been shown to correlate with functional outcomes. We propose that corneal staining, a clinically meaningful dry eye parameter, should be used as a standard objective outcome measure across all clinical trials evaluating dry eye treatments. We justify this based on evidence regarding its relationship to vision and vision related quality-of-life. In addition, corneal staining has been shown to correlate with ocular surface inflammation, a well elucidated aspect of dry eye pathophysiology and an active area in therapeutics research. No one outcome measure explored herein correlates perfectly to this heterogenous disease. However, there is mounting evidence showing the correlation between corneal staining and functional visual indices. We hope that future clinical trials will standardize corneal staining as a measure to determine the efficacy of interventions and justify their clinical utility.
Collapse
Affiliation(s)
- Kyle J Hirabayashi
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Esen K Akpek
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sumayya Ahmad
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
7
|
Maguire MG. Best Practices for the Design of Clinical Trials Related to the Visual System. Annu Rev Vis Sci 2021; 7:867-886. [PMID: 34297597 DOI: 10.1146/annurev-vision-093019-113930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Clinical trials for conditions affecting the visual system need to not only conform to the guidelines for all clinical trials, but also accommodate the possibility of both eyes of a single patient qualifying for the trial. In this review, I present the interplay of the key components in the design of a clinical trial, along with the modifications or options that may be available for trials addressing ocular conditions. Examples drawn from published reports of the design and results of clinical trials of ocular conditions are provided to illustrate application of the design principles. Current approaches to data analysis and reporting of trials are outlined, and the oversight and regulatory procedures to protect participants in clinical trials are discussed. Expected final online publication date for the Annual Review of Vision Science, Volume 7 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Collapse
Affiliation(s)
- Maureen G Maguire
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104;
| |
Collapse
|
8
|
Beckman K, Katz J, Majmudar P, Rostov A. Loteprednol Etabonate for the Treatment of Dry Eye Disease. J Ocul Pharmacol Ther 2020; 36:497-511. [PMID: 32391735 PMCID: PMC7482125 DOI: 10.1089/jop.2020.0014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Dry eye disease (DED) is a common ocular condition that can impair vision and may adversely impact quality of life. Due to the inflammatory nature of this disorder, topical corticosteroids are an effective treatment option, particularly for moderate-to-severe DED when first-line treatments, such as ocular lubricants, are insufficient. Loteprednol etabonate (LE) is a retrometabolically designed corticosteroid with a low propensity to cause corticosteroid-related adverse effects, such as elevated intraocular pressure (IOP). This review was conducted to provide an assessment of published studies on the use of LE for treatment of inflammation associated with DED. Twelve prospective and 2 retrospective studies evaluating LE ophthalmic suspension 0.5% and 2 prospective studies evaluating LE ophthalmic gel 0.5% were identified. LE given as monotherapy or with artificial tears (AT) improved signs of DED, especially among patients with a more pronounced inflammatory component, and also improved DED symptoms compared to baseline and/or control. Treatment with LE before cyclosporine A (CsA) therapy reduced stinging upon CsA initiation and provided more rapid relief of DED signs and symptoms than CsA plus AT alone. In patients with meibomian gland dysfunction, LE alone, or in addition to eyelid scrubs/warm compresses, reduced clinical signs and symptoms, and tear proinflammatory cytokine levels. Overall, LE was safe and well tolerated, with minimal effects on IOP. While larger and longer-term studies are warranted, these data support the use of LE as a safe and effective treatment option for DED.
Collapse
Affiliation(s)
- Kenneth Beckman
- Comprehensive Eyecare of Central Ohio, Westerville, Ohio, USA.,Department of Ophthalmology, Ohio State University, Columbus, Ohio, USA
| | - James Katz
- The Midwest Center for Sight, Des Plaines, Illinois, USA
| | - Parag Majmudar
- Chicago Cornea Consultants, Hoffman Estates, Illinois, USA
| | | |
Collapse
|
9
|
Asbell PA, Maguire MG. Why DREAM should make you think twice about recommending Omega-3 supplements. Ocul Surf 2019; 17:617-618. [PMID: 31415816 DOI: 10.1016/j.jtos.2019.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/10/2019] [Accepted: 08/05/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Penny A Asbell
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
| | | |
Collapse
|
10
|
|