Researchers have discovered that regular use of tear substitutes diminishes dry eye symptoms considerably in patients with neovascular age-related macular degeneration (nAMD) who receive frequent intravitreal injections (IVIs). In a prospective randomized bicenter study, patients who applied artificial tears daily showed significant improvement in their Ocular Surface Disease Index (OSDI) scores, and sustained lubrication may preserve the ocular surface in the long term. The study was conducted by Héloïse Torres-Villaros and colleagues published in the journal of Ophthalmology and Therapy.
Repeated intravitreal injections of anti-VEGF every 4–8 weeks for several years are common for patients with nAMD. These repeated interventions can compromise the ocular surface and cause dry eye symptoms, which detract from patient comfort and compliance. Artificial tears are used regularly to alleviate dryness, but little has been known about whether daily use on a regular basis (continuous) is superior to the use over a short period (intermittent) after injections. This study was conducted to explain the effect of these two methods on dry eye consequences.
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
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