Comparative Performance of Artificial Tear Drops Assessed with Objective Non-Invasive Imaging

Emily Rose White,1,* Ishan Amin Khwaja,2 Nicholas Fazio,1,* Andre Galenchik-Chan,3 Lauren Langman,3 Deborah M Li,3 Sarah Weissbart,1 Timothy Chou,1 Farzan M Gorgani,1 Liqun Huang,4 Konstantinos Tourmouzis,5 Basil Rigas,1,4,* Robert Honkanen1,* 1Department of Ophthalmology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA; 2Stony Brook University, Stony Brook, NY, USA; 3Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA; 4Department of Family, Population and Preventive Medicine, Stony Brook University, Renaissance School of Medicine, Stony Brook, NY, USA; 5Royal United Hospitals Bath NHS Foundation Trust, Bath and North East Somer, UK*These authors contributed equally to this workCorrespondence: Robert Honkanen, Department of Ophthalmology, Stony Brook University Hospital, Health Science Center, Level 2 Room 152, Stony Brook, NY, 11794, USA, Tel +1-631-444-6476, Fax +1-631-444-1543, Email [email protected]: To perform a comparative analysis of 13 over the counter artificial tear formulations and perflourohexyloctane assessing performance using objective, non-invasive imaging. The data provides a rationale to make better informed therapeutic decisions regarding their use.Patients and Methods: Prospective, sequential study of 13 drop formulations in participants over 18 years of age. Tear meniscus height, non-invasive keratographic break up time, and central lipid layer thickness were measured before and 5 and 15 minutes after drop administration. Outcomes were compared using linear mixed models. Predictors included group (between-subjects), time (within-subjects), and the group by time interaction.Results: One hundred and thirty-seven participants, mean age 67 years (54.3% female), were evaluated. Most drops showed increased tear meniscus height at 5 and 15 minutes compared to baseline. Changes in non-invasive keratographic break up time and lipid layer thickness were more variable. A few artificial tears demonstrated better performance with regards to tear meniscus height, non-invasive keratographic break up time or lipid layer thickness; but no single drop outperformed others across all three measured endpoints. Perflourohexyloctane did not show better performance in any test parameter.Conclusion: The performance of various over-the-counter artificial tears can be determined with non-invasive imaging technologies. Certain drops can outperform others with regard to individual test parameters suggesting that personalization or optimization of therapy may be possible. Both active and inactive ingredients contribute to the efficacy of artificial tears. Further work is needed to determine if differences observed here translate into meaningful clinical differences for dry eye disease treatment. This report highlights the complexity of dry eye disease and the need for ongoing work to find optimal ways to treat the ocular surface.Keywords: dry eye disease, perflourohexyloctane, tear meniscus height, lipid layer thickness, non-invasive keratographic break up time, LipiView II, Oculus Keratograph 5M