title: Noninvasive, objective, multimodal tear dynamics evaluation of 5 over-the-counter tear drops in a randomized controlled trial.
abstract: OBJECTIVE
  To assess the ability of a noninvasive, objective, multimodal system to compare the efficacy and optical quality of 4 different groups of 5 over-the-counter tear drops.
  
  
  METHODS
  Wavefront sensing and optical coherence tomography (OCT) were used to objectively assess visual quality and tear volume, respectively, after the over-the-counter tear drops [2 polyethylene glycol (PEG)-400, 1 carboxymethyl cellulose (CMC), 1 polyvinyl alcohol/PEG-400 (PVA), and 1 glycerine/polysorbate-80] were administered to 23 patients with aqueous-deficient dry eye in a randomized, controlled, double-masked trial. Measurements at each of the 5 visits were taken from both eyes at baseline and 5, 20, and 40 minutes after drop instillation.
  
  
  RESULTS
  At 5 minutes after drop instillation, the 2 PEG drops showed significant worsening of visual quality (-128.87%, P = 0.001) compared with CMC, PVA, and glycerine drops. Tear volume was elevated significantly with PEG and CMC drops at 5 minutes (+33.2%, P = 0.002; +29.9%, P < 0.001) compared with the other groups. Subjects with a Schirmer score of less than 5 mm at 5 minutes showed improvement in visual quality with PEG drops, whereas those with a fluorescein staining score of 1 to 2 showed improvement with both PEG and CMC drops. A trend toward decreasing visual quality with increasing tear meniscus was noted.
  
  
  CONCLUSIONS
  Noninvasive multimodal imaging has the potential to evaluate tear dynamics and the efficacy of artificial tears objectively. Certain artificial tear components and the temporary increase in tear volume after instillation of artificial tears may contribute to transient reduction of visual quality.
authors.affiliation: Ocular Surface Laboratory, University of Rochester, Rochester, NY, USA.
authors.forename: Cynthia I
authors.initials: CI
authors.lastname: Tung
authors.forename: Ranjini
authors.initials: R
authors.lastname: Kottaiyan
authors.forename: Shizuka
authors.initials: S
authors.lastname: Koh
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.forename: Geunyoung
authors.initials: G
authors.lastname: Yoon
authors.forename: James M
authors.initials: JM
authors.lastname: Zavislan
authors.forename: Steve R
authors.initials: SR
authors.lastname: Davio
authors.forename: James V
authors.initials: JV
authors.lastname: Aquavella
mesh_terms: D000328:Adult; D002266:Carboxymethylcellulose Sodium / Q000494:pharmacology; D019781:Corneal Topography; D004311:Double-Blind Method; D004338:Drug Combinations; D015352:Dry Eye Syndromes / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D005260:Female; D005990:Glycerol / Q000494:pharmacology; D006801:Humans; D008297:Male; D004366:Nonprescription Drugs / Q000494:pharmacology*; D009883:Ophthalmic Solutions / Q000494:pharmacology*; D011092:Polyethylene Glycols / Q000494:pharmacology; D011136:Polysorbates / Q000494:pharmacology; D011142:Polyvinyl Alcohol / Q000494:pharmacology; D013666:Tears / Q000187:drug effects* / Q000378:metabolism; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D004338:Drug Combinations; D004366:Nonprescription Drugs; D009883:Ophthalmic Solutions; D011136:Polysorbates; D011092:Polyethylene Glycols; D011142:Polyvinyl Alcohol; D002266:Carboxymethylcellulose Sodium; D005990:Glycerol