Gaps in Current Knowledge and Priorities for Future Research in Dry Eye

Abstract

Purpose Dry eye, a common, yet under-recognized and evolving field, has few recommended treatment algorithms, mostly based on expert consensus rather than robust research evidence. There are high costs associated with managing dry eye and conducting research to identify effective and safe long-term treatments. To support evidence-based management of dry eye, our purpose was to identify and prioritize important clinical research questions for future clinical research. Methods We translated recommendations from the American Academy of Ophthalmology’s 2013 Preferred Practice Patterns for dry eye into answerable clinical research questions about treatment effectiveness. Clinicians around the world who manage patients with dry eye rated each question’s importance from 0 (not important) to 10 (very important) using a two-round online Delphi survey. We considered questions as “important” if ≥75% of respondents assigned a rating of 6 or more in Round 2. We mapped the identified important clinical research questions to reliable systematic reviews published up to March 2016. Results Seventy-five clinicians from at least 21 countries completed both Delphi rounds. Among the 58 questions, 24 questions met our definition of “important”: 9/24 and 7/24 addressed topical and systemic treatments, respectively. All four questions with the highest 25th percentiles addressed topical treatments. While 6/24 “important” questions were associated with four existing reliable systematic reviews, none of these reviews came to a definitive conclusion about treatment effectiveness. Conclusion We identified gaps pertaining to treatment options for dry eye. Future clinical research on the management of dry eye should strongly consider these prioritized questions.

Cochrane Eyes and Vision: a perspective introducing Cochrane Corner in Eye

“…This research has engaged clinical partners and addresses topics highly relevant to producing high quality reviews. Investigators at Cochrane Eyes and Vision US satellite have published methods papers on prioritizing reviews [13][14][15][16], practice guidelines [17][18][19], identifying clinical trials [20], strengths and limitations of data sources [21][22][23][24], and outcomes in Eyes and Vision trials and reviews [25][26][27][28][29], dissemination by co-publication [30], and network meta-analysis methods as applied to open angle glaucoma [31 32].…”

Research Questions and Outcomes Prioritized by Patients With Dry Eye

“…We previously identified 24 research questions (hereinafter referred to as questions) important to clinicians treating patients with dry eye. 11 We selected the 12 questions rated as most important by the clinicians to be prioritized by patients in the present study.…”

“…We previously surveyed clinicians managing dry eye to identify their most important unanswered clinical questions. 11 Most questions pertained to topical and other treatments already being used clinically. 11 Dry eye research prioritization efforts must also incorporate patient perspectives, 12 in part because assessments of both the disease process and treatment outcomes include the use of patient reports.…”

Prognostic value of changes in the cornea and conjunctiva in diabetes mellitus

“…При глубоком разрушении стромы появляются десцеметоцеле или язвы роговицы, сопровождающиеся перфорацией. Отличительной чертой последних являются отсутствие воспалительной реакции и превалирование расстройства обменных процессов, характерных для диабета [38]. Анамнез, продолжительность и динамическое наблюдение пациентов с СД являются основными факторами для дифференциальной диагностики.…”

“…При нарушении эпителиального слоя роговицы больные жалуются на чувство инородного тела за веками, светобоязнь, блефароспазм, плохую переносимость глазами ветра, пыли, кондиционированного воздуха и дыма, ухудшение зрительной работоспособности, колебания остроты зрения. Эти жалобы не строго патогномоничны для СД, так как могут появляться у больных с хроническими конъюнктивитами и синдромом ССГ [35][36][37][38][39].…”