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

Saldanha, Ian J. MBBS, MPH, PhD*; Dickersin, Kay MA, PhD; Hutfless, Susan T. PhD, SM; Akpek, Esen K. MD§

doi: 10.1097/ICO.0000000000001350

Purpose: Dry eye, a common yet underrecognized 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 2-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 met our definition of “important”: 9/24 and 7/24 addressed topical and systemic treatments, respectively. All 4 questions with the highest 25th percentiles addressed topical treatments. Although 6/24 “important” questions were associated with 4 existing reliable systematic reviews, none of these reviews came to a definitive conclusion about treatment effectiveness.

Conclusions: 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.

Supplemental Digital Content is Available in the Text.

Departments of *Epidemiology; and

Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;

Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD; and

§Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD.

Reprints: Ian J. Saldanha, MBBS, MPH, PhD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room E6035, Baltimore, MD 21205 (e-mail:

Supported by The National Institutes of Health (Grant Number EY020140) and Cochrane Eyes and Vision (Grant Number U01 EY020522).

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received June 03, 2017

Received in revised form July 12, 2017

Accepted July 12, 2017

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