Comparison of Dry Eye Treatment Outcomes in Patients with or without Autoimmune Disease.

Purpose: Assess and compare the efficacy of cyclosporine and lifitegrast in patients with dry eye disease (DED) and with or without autoimmune disease.

Methods: 430 DED patients from 2018 to 2023 in Wilmer Institute who did or did not receive cyclosporine and/or lifitegrast were selected. Demographics, cataract surgery status, autoimmune comorbidities, visual acuity (VA), and punctate epithelial erosions (PEE) were assessed between treatment groups. VA was assessed using Snellen measurements converted logMAR (logarithm of the minimum angle of resolution) scores. PEE was measured using the integer PEE grade scale, with 0 defined as no PEE. Chi-square and Fisher's Exact test were used to compare categorical variables across groups. Kendall correlation was used to assess the overall trend of VA and PEE grades over time and to determine the number of eyes with significant improvement. Multiple regression was used to analyze the effect of various variables on VA and PEE changes.

Results: One hundred and sixty patients received cyclosporine, 45 received lifitegrast, 59 received both, and 166 were controls. The differences in race, age at visit, and sex were not found to be significantly different between treatment groups, as well as the number of autoimmune disease patients. Kendall correlation of logMAR scores revealed that out of 575 eyes with three or more best-corrected VA measurements, only 31 eyes saw significant vision improvement. The number of eyes with improved VA between treatment groups was not significantly different. Using similar statistical methods, the number of eyes with lowered PEE grades was not significantly different between groups. When analyzing changes in logMAR, multiple regression suggested that treatment with cyclosporine and both cyclosporine and lifitegrast is associated with improved visual acuity only if patients also had an autoimmune disease (cyclosporine β = 0.076, p = 3E-6; Both, β = 0.083, p = 5E-5; cyclosporine:autoimmune β = -0.072, p = .010; Both:autoimmune β = -0.181, p = 2E-6). Regression of change in PEE grades revealed that cyclosporine is similarly associated with lower grades in autoimmune patients (cyclosporine:autoimmune β = -0.520, p = 8E-12).

Conclusions: Cyclosporine and lifitegrast treatment does not seem to significantly improve visual acuity and PEE compared to control. However, the presence of autoimmune disease significantly modulates the efficacy of DED treatment.