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.

1
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💀
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Chemo☢️
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Morphine💊
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75
DangerousModerateSafe

Time to Effect

4-12 weeks

Duration

lifetime

Response Rate

65%

Remission Rate

25%

Number Needed to Treat (NNT)

4

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
2
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💧
75
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

lifetime

Response Rate

60%

Remission Rate

20%

Number Needed to Treat (NNT)

5

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
3
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💧
75
DangerousModerateSafe

Time to Effect

Within days to 2 weeks

Duration

lifetime

Response Rate

55%

Remission Rate

15%

Number Needed to Treat (NNT)

4

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
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
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
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Morphine💊
Antibiotics💉
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65
DangerousModerateSafe

Time to Effect

Days to 1 week

Duration

2-4 weeks (pulsed therapy)

Response Rate

75%

Remission Rate

%

Number Needed to Treat (NNT)

3

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
5
Punctal Plugs (Silicone or dissolvable)
70% Effectiveness• 80% Confidence• 85% Safety• 25 trials• 3.5K participants
MODERATE EvidenceExcellent ValueDose: 1-4 plugs per patient
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
85
DangerousModerateSafe

Time to Effect

immediate

Duration

temporary (dissolvable) or permanent (silicone)

Response Rate

60%

Remission Rate

15%

Number Needed to Treat (NNT)

5

Common Side Effects:

Foreign body sensation: 10%
Epiphora (excessive tearing): 5%
Plug extrusion: 15%

Annual Cost of Care

Drug Cost

$0

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
6
Omega-3 Fatty Acids (EPA/DHA)
60% Effectiveness• 70% Confidence• 85% Safety• 9 trials• 12K participants
MODERATE EvidencePoor ValueDose: 1000-2000mg EPA+DHA daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
85
DangerousModerateSafe

Time to Effect

1-3 months

Duration

lifetime

Response Rate

40%

Remission Rate

5%

Number Needed to Treat (NNT)

9

Common Side Effects:

Fishy aftertaste: 10%
Gastrointestinal upset: 5%

Annual Cost of Care

Drug Cost

$400

Monitoring

$500

Side Effects

$0

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
7
Artificial Tears
50% Effectiveness• 95% Confidence• 90% Safety• 235 trials• 150K participants
HIGH EvidenceExcellent ValueDose: 1-6+ drops daily as needed
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
90
DangerousModerateSafe

Time to Effect

immediate

Duration

lifetime

Response Rate

85%

Remission Rate

2%

Number Needed to Treat (NNT)

2

Common Side Effects:

Transient blurred vision: 1%
Mild irritation: 0.5%

Annual Cost of Care

Drug Cost

$500

Monitoring

$100

Side Effects

$0

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