Evidence Lacking in Study of Artificial Tear Use Following Anti-VEGF Injections

Artificial tears do not significantly affect ocular surface parameters in patients treated with intravitreal injections of anti-vascular endothelial growth (anti-VEGF) agents, according to research published in Clinical Ophthalmology. However, the researchers believe the use of artificial tears may confer long-term ocular surface benefits to patients undergoing intravitreal injections.

“Intravitreal injections of anti-VEGF agents significantly impact ocular surface health,” the researchers explain. “The use of artificial tears may help to keep the tear film stable.

Researchers conducted a randomized, prospective, comparative study to assess the use of artificial tears in patients undergoing anti-VEGF injections.

The researchers considered 34 eyes of 34 patients (62% men and 38% women; mean age, 76.56±8.23 years [range, 51-88]). Patients were randomly assigned to receive either Systane Hydration (Alcon Laboratories) or the Viscofresh 10mg/mL (Allergan Inc), with 16 in the Systane Hydration group and 18 in the Viscofresh group.

All patients underwent a subjective and objective evaluation of the ocular surface. The primary outcome measure was the Ocular Surface Disease Index (OSDI). Secondary outcome measures included Dry Eye Questionnaire (DEQ)-5, tear meniscus height (TMH), first and average non-invasive Keratograph Break-Up Time (NIKBUT), bulbar conjunctival redness, meibography and the Vision Break-Up Time (VBUT). Patients attended 5 follow-up visits (days 0, 7, 30, 37, and 60) and continued intravitreal injection treatment during the study (days 0, 30, and 60). 

At the baseline visit, the investigators randomly assigned the patients to receive either the Systane Hydration or Viscofresh artificial tears. During the first month of the study, patients did not receive any artificial tear treatment; they were instructed to begin treatment (1 drop of the assigned study treatment 3 times a day for 30 days) beginning in the second month of the study.

The researchers found no significant differences for any of the parameters examined between eyes when treated or not treated with artificial tears nor based on the type of artificial tears used (P >.05 for all).

“Despite this, some parameters, such as the OSDI and DEQ-5, did show a trend toward lower values (reduced symptoms) over the course of the study,” the researchers report. Prior research into the use of artificial tears in patients undergoing anti-VEGF injections shows symptomatic improvement substantially exceed the OSDI’s minimal clinically important difference range, from 4.5 to 7.3 units for mild or moderate dry eye disease and from 7.3 to 13.4 for severe disease. 

This study found no significant changes in TMH, NIKBUT, redness, or meibography during the treatment. “However, despite there being no statistical significance, there was an improvement in tear film stability measured with the NIKBUT, mainly for the first but also for the average values,” according to the study authors. “It should be borne in mind that tear film instability is a key pathogenic factor in dry eye disease and improving this is a basic strategy for managing the disease.”

A limitation of the study was the small sample size.

Disclosure: This research was supported by Alcon Laboratories, Inc. Some study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.