Dry Eye Disease Management Via Technological Methods- A Systematic Review And Network Meta-Analysis
Published 2024 - 42nd Congress of the ESCRS
Reference: FP07.01 | Type: Free paper | DOI: 10.82333/h7tr-6894
Authors: Dror Ben Ephraim Noyman 1 , Clara Chan 2 , Itamar Arbel 3 , Or Yosefi 4 , Michael Mimouni 1 , Margarita Safir* 5
1Ophthalmology,Rambam Health Care Campus,Haifa,Israel, 2Ophthalmology and Vision Sciences,University of Toronto,Toronto,Canada, 3Ophthalmology,Meir Medical Center,Kfar Saba,Israel, 4Military Medicine,The Hebrew University of Jerusalem,Jerusalem,Israel, 5Ophthalmology,Shamir Medical Center,Zerifin,Israel
Purpose
To review the efficacy of novel technological methods which have emerged for dry eye disease (DED) management during the last two decades.
Setting
A systematic review and meta-analysis
Methods
A systematic search of the electronic databases of PubMed, Scopus, and Embase, for all peer-reviewed published randomized control trials which included clinical outcomes of technological methods for DED management was performed. Individual study data were extracted and Standardized Mean Differences (SMDs) were evaluated in a network meta-analysis, including total symptom scores, meibomian gland secretion score, fluorescein corneal staining (FCS) score and tear break-up time (TBUT). Treatment effectiveness was evaluated compared to placebo using forest plots and ranked according to league tables examining combined direct and indirect comparisons.
Results
Of 3727 studies, 54 were included, describing 4298 patients, evaluating 18 DED treatment methods. For DED signs, either TearCare with meibomian gland expression (MGX) or IPL (intense pulsed light)-based treatments produced the best outcomes at 1 and 3 months (at 3 months for TBUT TearCare+MGX, SMD -4.90, 95%CI [-7.14, -2.65] and IPL+MGX+probing, SMD -2.61, 95%CI [-5.02, -0.21]; meibomian gland secretion for TearCare+MGX, SMD -18.43, 95%CI [-23.92, -12.95] and for IPL+MGX+probing , SMD -3.25, 95%CI [-5.63, -0.87]). Total symptoms were best with the IPL-based treatments (at 3 months for IPL+MGX+probing, SMD -2.81, 95%CI [-4.65, -0.97]; for IPL+MGX, SMD -1.70, 95%CI [-2.94, -0.47].
Conclusions
IPL-based DED treatments were favorable among technological methods at 1 and 3-months. While TearCare exhibited superiority for DED signs, these results should be interpreted with caution since they are based on a single study with a possible conflict of interest. Further prospective direct comparative studies with longer follow-up are needed.