Continuous Use of Tear Substitutes Improves Dry Eye in Age-related Macular Degeneration Patients

The trial included 65 patients with nAMD, mean age 83.1 ± 6.0 years, who had already received a mean of 28.5 ± 20.3 intravitreal injections. The patients were randomly assigned to two groups:

• Intermittent Group: Had 1.5% povidone artificial tears only for three days following each injection

• Continuous Group: Applied an ophthalmic emulsion with 0.18% sodium hyaluronate four times a day during the trial

The main outcome was change in OSDI score from baseline to the fourth IVI day.

Secondary outcomes were Schirmer test scores, tear break-up time (TBUT), and Oxford staining scores, which measure tear amount, stability, and ocular surface injury respectively.

Main Findings

• The continuous group had a mean decrease in OSDI score of −6.6 ± 13.5 points, indicative of decreased dry eye symptomatology, versus an increase of +0.6 ± 13.7 points in the intermittent group (p = 0.04). This change was statistically significant, showing an actual advantage from frequent tear application.

• Schirmer test score: No significant difference

• TBUT: No improvement

• Oxford staining score: Comparable between groups

These findings indicate that although subjective symptoms improved, the objective physical signs of dry eye were relatively unchanged during the short follow-up.

This research proved that frequent use of tear substitutes greatly enhances dry eye symptoms, as reflected by decreased OSDI scores, in patients undergoing repeated intravitreal injections for nAMD. Further research with longer follow-up may better define the long-term value of this regimen.

Reference:

Torres-Villaros, H., Giocanti-Aurégan, A., Doan, S. et al. Continuous versus Intermittent Use of Tear Substitutes in Patients Treated with Anti-VEGF for Neovascular Age-Related Macular Degeneration: The TREDIA Study. Ophthalmol Ther (2025). https://doi.org/10.1007/s40123-025-01201-3