SYSTANE® BALANCE Symptoms (OSDI) & Inflammatory Biomarkers

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the ability of SYSTANE® BALANCE and SYSTANE® Gel to improve comfort in subjects with dry eyes.

Official Title
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Study to Evaluate the Efficacy of SYSTANE® BALANCE in Reducing Symptoms and Inflammatory Biomarker Expression of HLA-DR and Tear Film Cytokines in Dry Eye Subjects With Lipid Deficiency

Conditions
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Dry Eye Syndrome

Intervention / Treatment
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* Other: SYSTANE® BALANCE Lubricant Eye Drops
* Other: SYSTANE® Gel


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Read, sign, and date the Informed Consent Document; Must not have used any topical ocular drops for approximately 24 hours prior to Visit 1; Meet the protocol-specified dry eye criteria at Screening Visit (Visit 1); Intraocular pressure (IOP) less than or equal to 22 millimeters of mercury (mmHg) in both eyes; Other protocol-defined inclusion criteria may apply. Exclusion Criteria: History or evidence of ocular or intraocular surgery or serious trauma in either eye within the past 6 months; Current punctal occlusion of any type (e.g., collagen plugs, silicone plugs); History or evidence of epithelial herpes simplex keratitis (dendritic keratitis); vaccinia; active or recent varicella viral disease of the cornea and/or conjunctiva; chronic bacterial disease of the cornea and/or conjunctiva and/or eyelids; mycobacterial infection of the eye; and/or fungal disease of the eye; Use of any concomitant topical ocular medications during the study period; Currently using Restasis but unwilling to discontinue its use 1 month prior to screening and for the entire study period; Use of systemic medications that may contribute to dry eye unless on a stable dosing regimen for a minimum of 30 days prior to Visit 1 and that remains stable throughout the study; Uncontrolled ocular conditions such as uveitis, glaucoma or any other ocular condition that may preclude the safe administration of either drop under investigation; Other protocol-defined exclusion criteria may apply.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Systane Balance<br>SYSTANE® BALANCE Lubricant Eye Drops, 1 drop in each eye 4 times a day for 30 days | Other: SYSTANE® BALANCE Lubricant Eye Drops<br> <br> * Other names: SYSTANE® BALANCE;|
| Active Comparator: Systane Gel<br>SYSTANE® Gel, 1 drop in each eye 4 times a day for 30 days | Other: SYSTANE® Gel<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ocular Comfort Measured as Mean Change From Baseline in OSDI Score by Visit | The Ocular Surface Disease Index (OSDI) is a 12-question validated questionnaire used to measure ocular symptoms, visual function, and environmental factors that may affect a patient's vision. The OSDI scoring scale ranges from 0 to 100. The lower the score, the more symptomatic relief from dry eye symptoms a patient experiences. Baseline-adjusted scores were tabulated; a negative number change from baseline indicates a perceived improvement in ocular comfort. | Baseline (Day 0), Day 14, Day 30 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean Change From Baseline in Best-corrected Visual Acuity (BCVA) by Visit | BCVA (with spectacles or other visual corrective devices) was determined using an ETDRS or modified EDTRS chart and measured in logMAR (logarithm of the minimum angle of resolution). Baseline-adjusted logMAR values were tabulated; a negative number change from baseline indicates better visual acuity. Each eye was assessed individually. Both eyes contributed to the mean. | Baseline (Day 0), Day 14, Day 30 | 
| Percentage of Eyes With Normal Slit-lamp Assessment | An undilated slit lamp exam was performed to examine the regions of the eye: orbit/lids, conjunctiva, cornea, anterior chamber, iris and lens. Each region was graded normal or abnormal. The percentage of eyes with normal assessments by region is reported. Each eye was assessed individually. Both eyes were included in the tabulation. | Baseline (Day 0), Day 14, Day 30 | 
| Meibomian Gland Expression | Meibomian gland expression (ie, pressing on the meibomian glands to excrete oil) was performed by the investigator during undilated slit lamp examination and graded on a 4-point scale where 0=normal, clear oil expressed and 3=congealed or no material expressed. Each eye was assessed individually. Both eyes contributed to the mean. | Baseline (Day 0), Day 14, Day 30 | 
| Mean Change From Baseline in Non-invasive Keratographic Tear Break up Time (NIKBUT) by Visit | NIKBUT (time required for dry spots to appear on the surface of the eye after blinking) was measured in seconds using the Oculus keratograph 5M. Baseline-adjusted scores were tabulated; a positive number change from baseline indicates improvement. Each eye was assessed individually. Both eyes contributed to the mean. | Baseline (Day 0), Day 14, Day 30 | 
| Mean Change From Baseline in Tear Meniscus Height (TMH) by Visit | TMH (the distance between the line of reflection along the top of the tear prism to the edge of the eyelid) was measured in millimeters using the Oculus keratograph 5M. Baseline-adjusted scores were tabulated; a positive number change from baseline indicates improvement. Each eye was assessed individually. Both eyes contributed to the mean. | Baseline (Day 0), Day 14, Day 30 | 
| Mean Change From Baseline in Ocular Surface Staining by Visit | Ocular surface staining (damage to the ocular surface) was assessed using non-toxic ophthalmic dye during slit-lamp review. Corneal and conjunctival staining were graded as per the National Eye Institute (NEI) pictorial scale. The ocular staining score ranges from 0 to 3. The lower the score, the less signs of dry eye disease a patient exhibits. Baseline-adjusted scores were tabulated; a negative number change from baseline indicates an improvement. Each eye was assessed individually. Both eyes contributed to the mean. | Baseline (Day 0), Day 14, Day 30 | 
| Mean Change From Baseline in Tear Inflammatory Cytokine Expression at Day 30 | A tear sample was collected and cytokine (small proteins) levels were analyzed using a High Sensitive Human Cytokine MilliPlex kit and measured in picograms/milliliter (pg/mL). Baseline-adjusted scores were tabulated; a negative number change from baseline indicates improvement. Each eye was assessed individually. Both eyes contributed to the mean. | Baseline (Day 0), Day 30 | 
| Mean Change From Baseline for % HLA-DR Inflammatory Biomarker Expression at Day 30 | Conjunctival samples were collected by Impression Cytology (IC) and analyzed in a lab. The number of cells expressing the inflammatory marker HLA-DR (as a percentage of total cells) was calculated. Baseline-adjusted scores were calculated as HLA-DR score at Day 30 minus HLA-DR score at baseline. A negative baseline-adjusted value indicates an improvement. Each eye was assessed individually. Both eyes were included in the mean. | Baseline (Day 0), Day 30 | 
| Mean Change From Baseline mRNA for % HLA-DR and TNF-alpha Gene Expression at Day 30 | Conjunctival samples were collected by Impression Cytology (IC) and analyzed in a lab. Total RNA was isolated. The number of cells expressing the inflammatory marker (as a percentage of total cells) was calculated. Baseline-adjusted scores were calculated as score at Day 30 minus score at baseline. A negative baseline-adjusted value indicates an improvement. Each eye was assessed individually. Both eyes were included in the mean. | Baseline (Day 0), Day 30 | 
| Mean Change From Baseline in Dry Eye Status as Measured by the Schirmer's Test by Visit | Dry eye status was assessed using the Schirmer's test. The investigator placed a paper strip on the eye under the lower lid for a specified time period. The length of the strip wetted by the tears was measured in millimeters. Baseline-adjusted values were tabulated; a positive number change from baseline indicates an improvement. Each eye was assessed individually. Both eyes contributed to the mean. | Baseline (Day 0), Day 14, Day 30 | 
| Mean Change From Baseline in Intraocular Pressure (IOP) by Visit | IOP (fluid pressure inside the eye) was assessed using Goldmann applanation tonometry and measured in millimeters of mercury (mmHg). A higher IOP can be a greater risk factor for developing glaucoma or glaucoma progression (leading to optic nerve damage). Baseline-adjusted values were tabulated. Each eye was assessed individually. Both eyes contributed to the mean. | Baseline (Day 0), Day 14, Day 30 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dry eye, Lipid deficiency, Inflammatory markers