A Decade of Effective Dry Eye Disease Management with Systane Ultra (Polyethylene Glycol/Propylene Glycol with Hydroxypropyl Guar) Lubricant Eye Drops

Figures & data

Figure 1 Mechanism of action of PEG/PG with HP GUAR. Image courtesy with permission from Alcon.

Abbreviations: HP GUAR, hydroxypropyl-guar; PEG, polyethylene glycol; PG, propylene glycol.

Figure 2 Flow chart for literature search for publication screening and inclusion. *Search strings used: (i) (Systane Ultra) AND (dry eye disease OR DED OR dry eye syndrome OR DES or dry eye); (ii) ([polyethylene glycol OR PEG] AND [propylene glycol OR PG] AND [hydroxypropyl guar OR HP guar OR HPG]) AND (dry eye disease OR DED OR dry eye syndrome OR DES or dry eye); (iii) (Systane Ultra) AND (artificial tears OR ocular lubricants OR lubricant eye drops OR ATP); (iv) ([polyethylene glycol OR PEG] AND [propylene glycol OR PG] AND [hydroxypropyl guar OR HP guar OR HPG]) AND (artificial tears OR ocular lubricants OR lubricant eye drops OR ATP); and (v) (dry eye OR DED) AND (artificial tears AND lubricant). ^†After removing duplicates.

Table 1 Clinical Studies Using PEG/PG with HP Guar Lubricant Eye Drops in DED

Publication	No. of DED Patients Treated with PEG/PG with HP-Guar	No of Patients Treated with Comparator	Endpoints	Results
Davitt et al, 2010^Citation28	n = 52	Optive (CMC/glycerin) n = 53	Corneal staining	P < 0.0009 at day 14; P = 0.0106 at day 42 compared with Optive
			Conjunctival staining	P = 0.0475 at day 14; P = 0.00009 at day 42 compared with Optive
			Ocular symptoms score	No significant differences between groups
			TFBUT
			OSDI scores
			VF-14 scores
Fernandez et al, 2015^Citation32	n = 16 moderate-to-severe DED	None	Corneal staining	P < 0.0001 relative to baseline
			Conjunctival staining	No change
			TFBUT	P < 0.0001 relative to baseline
			DEWS score	P < 0.0001 relative to baseline
			OSDI score	P = 0.02 relative to baseline
			Cells expressing HLA-DR	P = 0.02 relative to baseline
Labetoulle et al, 2017^Citation33	n = 43	Optive (osmoprotective CMC/glycerin) n = 41	TOSS score	No significant differences between groups
			IDEEL score
Asbell et al, 2018^Citation34	N = 97 1 drop 4x/day (n = 34) vs as needed (n = 63)	None	TOSS score	No differences between groups
			IDEEL score
Ng et al, 2018^Citation18	n = 28	None	Tear osmolarity	P < 0.05 relative to baseline in worse eye
			NITBUT
			Corneal staining
			Conjunctival hyperemia	Improvements not significant
			Conjunctival staining
Aguilar et al, 2018^Citation35	n = 49	None	Goblet cell density	P < 0.0001 at days 30, 60, 90 relative to baseline
			Corneal staining
			Conjunctival staining
			TFBUT
Torkildsen, 2009^Citation36	N = 48	Optive (osmoprotective CMC/glycerin) n = 48 Crossover study	IVAD	P = 0.0365 at 90 min compared with Optive
			Median time at BCVA	No significant differences between groups
			Reading rate
			Functional blink rate
Guillon et al, 2011^Citation37	N = 27	Optive (osmoprotective CMC/glycerin) n = 27	VA	Superior to comparator in static and time-controlled visual performance for high-contrast optotypes
			OSDI scores	No significant differences between groups
			Subjective vision scores
			Subjective comfort scores
Torkildsen et al, 2017^Citation38	N = 41	Rohto (PG/povidone) n = 39	Ocular comfort scores	No significant differences between groups
			Corneal staining
			Conjunctival staining
			TFBUT
			Ora Calibra Ocular Discomfort Scale
			4-Symptom Questionnaire
			Ora Calibra Quality of Life Questionnaire
Corcoran et al, 2017^Citation39	N = 33 (+15 without DED)	Rohto (PG/povidone) n = 33 (+15 without DED)	Cooling score	No significant differences between groups
			Corneal staining
			Schirmer’s score
			OSDI
Kislan, 2010^Citation40	n = 40	Blink Tears (PEG) n = 40 crossover study	TBUT	Compared with baseline, Blink Tears significant improved TBUT (P = 0.003), but ULTRA did not (P = 0.320)
			Vision and blurring	Blink was more soothing and less blurring, as well as showing more improved vision and comfort (P < 0.043) than ULTRA
			Soothing and comfort
Waduthantri et al, 2012^Citation41	N = 15	Refresh (PEG/PG) N = 15	SANDE score	No significant differences between groups
			Corneal staining
			TFBUT
			Schirmer’s test
Wong et al, 2017^Citation43	n = 20	Optimel (Manuka (Leptospermum sp.) honey eye drops) n = 20 Crossover study	TFBUT	No significant differences between groups
			Conjunctival staining
			Ocular comfort index	P = 0.05
			OSDI	P = 0.02
Maharana et al, 2017^Citation44	n = 48	0.5% Carboxymethyl cellulose (CMC), n = 41 0.3% hydroxypropyl methylcellulose (HPMC), n = 31	OSDI	ULTRA superior to CMC but similar to HPMC at weeks 1 and 4
			TBUT
			Schirmer’s test
Kading, 2010^Citation46	N = 45 contact lens wearers PEG/PG with HP-guar (n = 23)	Sensitive Eyes (n = 22)	Corneal staining	No significant differences between groups
			VA
McDonald et al, 2014^Citation45	n = 89 contact lens wearers PEG/PG with HP-guar (n = 44)	No treatment (n = 45)	Increased comfortable wear time	P = 0.078 compared with no treatment
			End of day comfort	P = 0.007 compared with no treatment
			Overall dryness	P < 0.001 compared with no treatment
			End of day dryness	P = 0.04 compared with no treatment
Gokul et al, 2017^Citation47	n = 30 Systane Ultra applied to one eye; Systane Balance (PG + HP-guar) applied to the other eye	Systane Balance (PG + HP-guar)	Low contrast glare acuity	Significantly more improved in the Balance than in the Ultra group
			Lipid layer grade
			NIBUT
			Ocular comfort
			Temperature variation factor	No changes
			Tear meniscus height
Bitton et al, 2018^Citation48	n = 18 PEG/PG with HP-guar instilled at ambient temperature and after refrigeration		Comfort level	No effect of temperature
Labiris et al, 2017^Citation50	N = 180 following cataract surgery Fixed combination of tobramycin and dexamethasone (FCTD) for 3 wks followed by PEG/PG with HP-guar for 6 wks (n = 59)	FCTD for 3 wks followed by 0.1% hyaluronate for 6 wks (n = 60) or FCTD alone for 3 wks (control group; n = 61)	TFBUT	Better in both study groups than in the control group at all time points; no differences between the two study groups
			Foreign body sensation
			Subjective discomfort index
			Blinking discomfort	Better in both study groups at wk 1
			Stinging sensation	No significant differences among the 3 groups
			Tearing sensation
			Subjective discomfort index
			Central corneal thickness
			Central corneal sensitivity

Abbreviations: CMC, carboxymethyl cellulose; DED, dry eye disease; DEWS, Dry Eye WorkShop; HLA-DR, human leukocyte antigen D-related; IVAD, interval visual acuity decay; N, total number of subjects; n, number of subjects; NITBUT, non-invasive tear break‑up time; OSDI, ocular surface disease index; SANDE, Symptom Assessment in Dry Eye; TFBUT, tear firm breakup time; TOSS, total ocular surface staining; VA, visual acuity.

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