Effectiveness of interventions for dry eye: a protocol for an overview of systematic reviews

Abstract

IntroductionDry 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 analysisWe 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 disseminationThis 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 numberCRD42021279880.

The Problem With Dry Eye Trials

“…In this issue of JAMA Ophthalmology, McCann et al 1 are to be commended for undertaking a critical review of the literature on the efficacy and adverse effects of various dry eye therapies. Overall, 71 systematic reviews evaluating interventions for dry eye were included, and of the 26 systemic reviews deemed reliable, no conclusive evidence was identified for the effectiveness of any dry eye intervention.…”

“…Beyond issues with the trials themselves, it is important to also consider the limitations of systematic review designs and meta-analysis strategies. Only 37% of the systematic reviews included in the study by McCann et al 1 were deemed reliable, with incomprehensive literature search and inappropriate meta-analysis being the key methodologic limitations. The spectrum of quality among systematic reviews on ocular surface disease corroborate with findings from the recent Tear Film and Ocular Surface Society Evidence Quality Report 8 and emphasizes the importance of considering potential bias in the evidence synthesis process and whether or not the methods are appropriate for evaluating the research question.…”

“…At the same time, we need to understand that, in the US alone, billions of dollars per year are being spent on dry eye therapies, with a lack of strong evidence to support the effectiveness of many of these treatments. Taking into account findings highlighted by McCann et al in the current issue of JAMA Ophthalmology , clinicians can combine a balanced consideration of findings from systematic reviews while at the same time blending the science and art of medicine to treat our patients to the best of our abilities.…”

Patient barriers and facilitators for making environmental and behavioral modifications for dry eye in the United States

“…Despite the money spent on managing dry eye disease, there is a well-documented disconnect between the ocular surface signs of dry eye disease and patient-reported symptoms 8–10 . Although treatments may yield improvements in signs, patients may not experience improvement in symptoms or vice versa 8–10 .…”

“…Despite the money spent on managing dry eye disease, there is a well-documented disconnect between the ocular surface signs of dry eye disease and patient-reported symptoms 8–10 . Although treatments may yield improvements in signs, patients may not experience improvement in symptoms or vice versa 8–10 . Inadequate symptom relief may explain why patients often need additional interventions, such as over-the-counter artificial tears that are intended to directly lubricate the ocular surface and may be effective in alleviating symptoms of dry eye disease for short periods 11,12 .…”