Management of Dry Eye Disease: Expanding the Evidence-Base

Abstract

Dry eye disease (DED) is a common and highly symptomatic condition, affecting many millions of individuals around the world, therefore appropriate diagnosis and management is of high importance. Effective long-term management remains challenging, and frustrates clinicians and patients alike. A thorough review of the literature identified several research evidence gaps. To identify the most suitable tests and equipment, a randomised trial was conducted, comparing a novel multi-functional device to established methods. The Oculus Keratograph 5M was shown to be more reliable for key DED metrics, especially non-invasive breakup time (NIBUT), and was therefore selected for data collection. A systematic review of artificial tears was undertaken, to reveal deficits in the literature. Newer artificial tears, containing combination formulations are more effective in treating DED, and further research into molecular weight is indicated. A randomised crossover trial was conducted, comparing the relative efficacy of drops containing different molecular weights of sodium hyaluronate. The drops performed similarly, however further research is warranted. Another study assessed the efficacy of a novel treatment for meibomian gland dysfunction (MGD), using a multi-modal device with heated reusable attachments. The MGrx device is as effective as traditional debridement and expression, but has time, space and cost-saving advantages. A global survey of clinical practice patterns was also conducted, revealing changes in DED management between regions and over time. High quality research evidence is key to informing clinical practice. The work in this thesis fills knowledge gaps and adds to the evidence in artificial tears, the mainstay of DED management, and treatments for MGD, the leading cause of evaporative DED. The dissemination of its findings ensures that they can be translated into clinical care, resulting in a significant contribution to the field of evidence-based management of dry eye disease, for the benefit of clinicians and their patients.