Abstract
This systematic review and meta-analysis compares sodium hyaluronate (HY) with non-HY based artificial tears in the treatment of dry eye syndrome. A literature search for clinical trials comparing HY against non-HY preparations was conducted across PubMed, Cochrane Central Register of Controlled Trials and Scopus databases from inception up to May 2016. Majority of the 18 studies selected for review showed superiority of HY in improving ocular staining and symptoms. Randomized controlled trials (RCTs) examining Schirmer’s I (SH) and tear breakup time (TBUT) underwent further meta-analyses with calculation of pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs). 7 RCTs including 383 eyes randomized to HY and 596 eyes to non-HY preparations underwent meta-analysis for SH. 9 RCTs including 458 eyes randomized to HY and 651 eyes to non-HY preparations underwent meta-analysis for TBUT. By fixed-effects modelling, HY demonstrated greater improvement of SH compared to non-HY preparations (SMD, 0.238; 95% CI, 0.107 to 0.369; p < 0.001). By random-effects modelling, HY demonstrated less improvement of TBUT (SMD, −0.566; 95% CI, −1.099 to −0.0336; p = 0.037). In summary, neither preparation was shown to be consistently superior across all outcome measures. The difference in effect between preparations on SH and TBUT was not clinically significant.
Highlights
The International Dry Eye Workshop[1] defines dry eye syndrome (DES) as a multifactorial heterogeneous disease of the tear film and ocular surface that results in discomfort, visual acuity disturbance and tear film instability
Some have suggested that the variability in the Schirmer’s I (SH) I test is likely to be greater than the SH II test as SH I is influenced by reflex, in addition to baseline tear secretion[31]
This review examined 18 clinical trials comparing the efficacy of HY against alternative lubricant preparations
Summary
The International Dry Eye Workshop[1] defines dry eye syndrome (DES) as a multifactorial heterogeneous disease of the tear film and ocular surface that results in discomfort, visual acuity disturbance and tear film instability. A wide range of treatment options is available in the management of DES, including topical lubricants or artificial tear substitutes, ointments or gels, topical secretagogues, anti-inflammatory therapy, biologic tear substitutes, punctal occlusion, moisture chamber goggles and surgery. Sodium hyaluronate has emerged as an option in artificial tear therapy. A recent meta-analysis by Kong X. et al.[5] compared the effect of HY and non-HY preparations in symptomatic relief of subjects and could not demonstrate superiority of one preparation over the other. The comparative efficacy of both artificial tears with regard to all other common outcome measures of DES remains unclear.
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