Condition

Dry Eye Disease

Chronic lack of sufficient eye lubrication

54.7M

People Affected

466

Active Trials

2.7M

New Cases/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

Cyclosporine ophthalmic emulsion

85% Effectiveness• 90% Confidence• 75% Safety• 95 trials• 18K participants

HIGH EvidenceModerate ValueDose: One drop twice daily in each eye

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Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

4-12 weeks

Duration

lifetime

Response Rate

65%

Remission Rate

25%

Number Needed to Treat (NNT)

Common Side Effects:

Ocular burning/stinging: 17%

Eye redness: 5%

Discharge: 3%

Blurred vision: 2%

Annual Cost of Care

Drug Cost

$9,000

Monitoring

$600

Side Effects

$50

Total Annual

$9,650

Cost-Effectiveness

MODERATE

QALYs Gained

0.07

ICER

$95,000/QALY

Cost per Remission

$38,600

Cost per Responder

$14,846

Treatment Outcomes

Primary Outcomes

Ocular Surface Disease Index (OSDI)52/100 (moderate-severe)

-28.8% (-15 points)

Schirmer's Test (without anesthesia)7 mm/5min

+42.8% (+3 mm/5min)

Corneal Fluorescein Staining (NEI scale)7/15 (moderate)

-28.5% (-2 points)

Dryness Symptom Severity (0-4 scale)3.0/4 (severe)

-33.3% (-1.0 point)

Secondary Benefits

Tear Film Break-up Time (TFBUT)4 seconds

+37.5% (+1.5 seconds)

Conjunctival Hyperemia (0-4 scale)2.0/4 (moderate)

-25% (-0.5 points)

Foreign Body Sensation Severity (0-4 scale)2.5/4 (moderate)

-28% (-0.7 points)

Common Side Effects

Ocular burning/stinging

+17%

Eye redness

+5%

Discharge

+3%

Clinical Trial Phases:

Phase 3Phase 4

Lifitegrast ophthalmic solution

83% Effectiveness• 88% Confidence• 75% Safety• 29 trials• 6K participants

HIGH EvidenceModerate ValueDose: One drop twice daily in each eye

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Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

lifetime

Response Rate

60%

Remission Rate

20%

Number Needed to Treat (NNT)

Common Side Effects:

Eye irritation: 18%

Dysgeusia (unusual taste): 15%

Blurred vision: 3%

Headache: 2%

Annual Cost of Care

Drug Cost

$9,000

Monitoring

$600

Side Effects

$50

Total Annual

$9,650

Cost-Effectiveness

MODERATE

QALYs Gained

0.07

ICER

$110,000/QALY

Cost per Remission

$48,250

Cost per Responder

$16,083

Treatment Outcomes

Primary Outcomes

Eye Dryness Score (EDS)55/100

-20% (-11 points)

Inferior Corneal Staining Score (ICSS)2.2/4

-25% (-0.55 points)

Total Conjunctival Staining Score3.5/6

-20% (-0.7 points)

Secondary Benefits

Ocular Surface Disease Index (OSDI)50/100

-15% (-7.5 points)

Tear Break-up Time (TBUT)5 seconds

+10% (+0.5 seconds)

Schirmer's Test Score (unanesthetized)8 mm/5 min

+6.25% (+0.5 mm/5 min)

Common Side Effects

Eye irritation

+18%

Dysgeusia (unusual taste)

+15%

Blurred vision

+3%

Clinical Trial Phases:

Phase 3Phase 4

Varenicline solution (nasal spray)

78% Effectiveness• 85% Confidence• 75% Safety• 4 trials• 1.8K participants

MODERATE EvidenceExcellent ValueDose: One spray in each nostril twice daily

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Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

Within days to 2 weeks

Duration

lifetime

Response Rate

55%

Remission Rate

15%

Number Needed to Treat (NNT)

Common Side Effects:

Sneezing: 82%

Cough: 16%

Throat irritation: 13%

Annual Cost of Care

Drug Cost

$9,000

Monitoring

$600

Side Effects

$50

Total Annual

$9,650

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.06

ICER

$11,000/QALY

Cost per Remission

$64,333

Cost per Responder

$17,545

Treatment Outcomes

Primary Outcomes

Schirmer's Test Score (Tear Production)5 mm/5 min

+240% (+12 mm/5 min)

Ocular Surface Disease Index (OSDI) ScoreOSDI score: 55/100

-21.8% (-12 points)

Tear Film Break-Up Time (TBUT)4 seconds

+37.5% (+1.5 seconds)

Patient-Reported Dryness Score (NRS)Dryness score: 3.0/4

-30% (-0.9 points)

Secondary Benefits

Corneal Fluorescein Staining ScoreCorneal staining score: 2.0/3

-20% (-0.4 points)

Conjunctival Lissamine Green Staining ScoreConjunctival staining score: 2.5/3

-20% (-0.5 points)

Visual Analog Scale (VAS) for Ocular DiscomfortVAS ocular discomfort: 70/100 mm

-28.5% (-20 mm)

Common Side Effects

Sneezing

+82%

Cough

+16%

Throat irritation

+13%

Clinical Trial Phases:

Phase 3Phase 4

Loteprednol etabonate ophthalmic suspension (short-term)

75% Effectiveness• 90% Confidence• 65% Safety• 60 trials• 9K participants

HIGH EvidenceGood ValueDose: One drop 2-4 times daily, then taper

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

Days to 1 week

Duration

2-4 weeks (pulsed therapy)

Response Rate

75%

Remission Rate

Number Needed to Treat (NNT)

Common Side Effects:

Ocular pain/stinging: 10%

Blurred vision: 5%

Transient increase in IOP (low risk with short-term use): 1%

Annual Cost of Care

Drug Cost

$250

Monitoring

$50

Side Effects

$20

Total Annual

$320

Cost-Effectiveness

GOOD

QALYs Gained

0.02

Cost per Responder

$427

Treatment Outcomes

Efficacy Outcomes

Overall Effectiveness

+75%

Response Rate

+75%

Common Side Effects

Ocular pain/stinging

+10%

Blurred vision

+5%

Transient increase in IOP (low risk with short-term use)

+1%

Clinical Trial Phases:

Phase 3Phase 4

Punctal Plugs (Silicone or dissolvable)

70% Effectiveness• 80% Confidence• 85% Safety• 25 trials• 3.5K participants

MODERATE EvidenceExcellent ValueDose: 1-4 plugs per patient

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

immediate

Duration

temporary (dissolvable) or permanent (silicone)

Response Rate

60%

Remission Rate

15%

Number Needed to Treat (NNT)

Common Side Effects:

Foreign body sensation: 10%

Epiphora (excessive tearing): 5%

Plug extrusion: 15%

Annual Cost of Care

Drug Cost

Monitoring

$300

Side Effects

$100

Total Annual

$500

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.05

ICER

$25,000/QALY

Cost per Remission

$3,333

Cost per Responder

$833

Treatment Outcomes

Efficacy Outcomes

Overall Effectiveness

+70%

Response Rate

+60%

Remission Rate

+15%

Common Side Effects

Foreign body sensation

+10%

Epiphora (excessive tearing)

+5%

Plug extrusion

+15%

Clinical Trial Phases:

Phase 4

Omega-3 Fatty Acids (EPA/DHA)

60% Effectiveness• 70% Confidence• 85% Safety• 9 trials• 12K participants

MODERATE EvidencePoor ValueDose: 1000-2000mg EPA+DHA daily

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

1-3 months

Duration

lifetime

Response Rate

40%

Remission Rate

Number Needed to Treat (NNT)

Common Side Effects:

Fishy aftertaste: 10%

Gastrointestinal upset: 5%

Annual Cost of Care

Drug Cost

$400

Monitoring

$500

Side Effects

Total Annual

$900

Cost-Effectiveness

POOR

QALYs Gained

0.01

Cost per Remission

$8,000

Cost per Responder

$1,000

Treatment Outcomes

Primary Outcomes

Ocular Surface Disease Index (OSDI) Score50/100 points (moderate-severe DED)

-25% (-12.5 points)

Tear Break-up Time (TBUT)5 seconds

+30% (+1.5 seconds)

Corneal and Conjunctival Staining Score (Oxford Scale)7/15 points

-20% (-1.4 points)

Tear Osmolarity325 mOsm/L

-4.6% (-15 mOsm/L)

Secondary Benefits

Visual Analog Scale (VAS) for Ocular Discomfort60/100 mm

-20% (-12 mm)

Frequency of Artificial Tear Use4 times/day

-37.5% (-1.5 times/day)

Meibomian Gland Expressibility Score2/3 (moderate dysfunction)

-25% (-0.5 points)

Common Side Effects

Fishy aftertaste

+10%

Gastrointestinal upset

+5%

Clinical Trial Phases:

Phase 4

Artificial Tears

50% Effectiveness• 95% Confidence• 90% Safety• 235 trials• 150K participants

HIGH EvidenceExcellent ValueDose: 1-6+ drops daily as needed

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

immediate

Duration

lifetime

Response Rate

85%

Remission Rate

Number Needed to Treat (NNT)

Common Side Effects:

Transient blurred vision: 1%

Mild irritation: 0.5%

Annual Cost of Care

Drug Cost

$500

Monitoring

$100

Side Effects

Total Annual

$600

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.01

Cost per Remission

$30,000

Cost per Responder

$706

Treatment Outcomes

Primary Outcomes

Ocular Surface Disease Index (OSDI) ScoreOSDI score: 50/100 (severe dry eye)

-60% (-30 points)

Dryness Symptom Score (VAS)Visual Analog Scale for Dryness: 70/100 mm

-50% (-35 mm)

Corneal Fluorescein Staining Score (NEI Scale)Corneal Staining Score (NEI Scale): 3/15

-67% (-2 points)

Tear Film Break-up Time (TBUT)Tear Film Break-up Time: 4 seconds

+50% (+2 seconds)

Secondary Benefits

Conjunctival Lissamine Green Staining ScoreLissamine Green Staining Score: 4/9

-50% (-2 points)

Overall Ocular Comfort ScoreOverall Comfort Score: 7/10 (higher is worse discomfort)

-57% (-4 points)

Frequency of Artificial Tear UseArtificial Tear Use: 8 times/day

-50% (-4 times/day)

Common Side Effects

Transient blurred vision

+1%

Mild irritation

+0.5%

Clinical Trial Phases:

Phase 4