Dry Eye Disease Management Via Technological Methods: A Systematic Review and Network Meta-analysis

In recent years, various technological therapeutic modalities have emerged aiming to target the underlying pathophysiology of dry eye disease (DED).

A systematic search was conducted in PubMed, Scopus, and Embase databases up to July 29, 2023, using predefined search terms related to DED and technological treatments, including intense pulsed light (IPL), LipiFlow, TearCare, iLux, low-level light therapy (LLLT), and acupuncture. Randomized controlled trials (RCTs) evaluating technological interventions for DED with outcome measures for tear secretion, meibomian gland quality, tear break-up time (TBUT), corneal surface health, and symptom scores at 1-2 months post-treatment were included. Data extraction followed PRISMA guidelines. Risk of bias was assessed using Cochrane guidelines. A random-effects frequentist network meta-analysis model was employed, and standardized mean differences (SMDs) were calculated for comparative analyses. P-scores were used to rank treatment efficacy.

Ultimately, 45 RCTs involving 3455 patients were included. TearCare combined with meibomian gland expression (MGX) demonstrated the highest efficacy for improving meibomian gland secretion (SMD - 10.08, 95% CI - 13.35 to - 6.82). IPL-based treatments, including IPL combined with diquafosol sodium or LLLT, significantly improved TBUT and symptom scores, with IPL alone ranking highest for symptom relief (P-score 0.811). Acupuncture was the only intervention significantly superior to conservative treatment for increasing Schirmer test values (SMD - 0.69, 95% CI - 1.06 to - 0.32). LipiFlow demonstrated modest improvements but was not significantly superior to other technologies.

These findings underscore the potential of advanced technological interventions in the short-term management of DED and support the need for standardized, long-term comparative studies.