Technology-Based Dry Eye Interventions Rank Differently by Outcome

Key Takeaways

• Different technologies led different short-term endpoints, with TearCare plus meibomian gland expression topping gland secretion and IPL alone ranking highest for symptom relief.
• IPL-based approaches were associated with better tear break-up time and symptom scores, while acupuncture alone showed a significant advantage over conservative treatment for Schirmer values.
• The authors described these results as short-term comparisons and called for standardized studies with longer follow-up.

In a published network meta-analysis of technology-based dry eye interventions, TearCare plus meibomian gland expression ranked highest for meibomian gland secretion, with an SMD of -10.08 (95% CI, -13.35 to -6.82). The comparison spanned multiple technology-based approaches and ranked treatments across several distinct short-term outcome domains. Different interventions led different domains, with no single technology topping every endpoint in the broader systematic review and network meta-analysis. Overall, short-term comparative performance varied by the outcome measured.

Investigators searched PubMed, Scopus, and Embase through July 29, 2023, for randomized trials of technology-based dry eye disease interventions. The review included 45 randomized controlled trials involving 3,455 patients and evaluated IPL, LipiFlow, TearCare, iLux, low-level light therapy, acupuncture, and combination approaches. Those combinations included IPL with diquafosol sodium or low-level light therapy, and outcomes covered tear secretion, meibomian gland quality, tear break-up time, corneal surface health, and symptom scores. The evidence base was limited to randomized controlled designs, keeping the comparisons focused on trial-level data. Data extraction followed PRISMA guidance, bias was assessed with Cochrane guidance, and the random-effects frequentist network meta-analysis used standardized mean differences and P-scores at 1 to 2 months.

Across endpoints, TearCare plus meibomian gland expression led meibomian gland secretion, while IPL-based regimens were associated with gains in tear break-up time. For symptom relief, IPL alone had the highest P-score at 0.811, placing it above other evaluated technologies in the ranking analysis. Acupuncture was the only intervention significantly superior to conservative treatment for Schirmer test values, with an SMD of -0.69 and 95% CI of -1.06 to -0.32. Not every domain produced a clear separation between technologies, even when some approaches ranked well. The rankings shifted across measures, indicating that comparative performance depended on the endpoint rather than a universal treatment advantage.

LipiFlow showed modest improvement, but it was not significantly superior to other technologies across the compared outcomes. The evaluated landscape also included combination IPL regimens, such as IPL paired with diquafosol sodium or low-level light therapy. Within the technology-based interventions for dry eye disease, several approaches showed signals in specific domains without separating clearly from the broader field. The comparative pattern was more mixed for some platforms than for the highest-ranked interventions. No single device or adjunctive strategy led every reported domain in this short-term comparison.

The investigators described the findings as support for short-term management comparisons rather than proof of one best technology for dry eye disease. Because outcomes were measured 1 to 2 months after treatment, the synthesis was limited to near-term comparative performance. Their conclusion emphasized that the present network does not settle longer-term comparative questions across the available technologies. They also highlighted the need for standardized studies with longer follow-up to clarify how these interventions compare over time. The current evidence distinguishes short-term, outcome-specific performance rather than establishing a single best technology overall.