{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:19:56Z","timestamp":1789712396808,"version":"4.0.1"},"reference-count":26,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019562","name":"Synoptik-Fonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019562","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008397","name":"Velux Fonden","doi-asserted-by":"publisher","award":["00048932"],"award-info":[{"award-number":["00048932"]}],"id":[{"id":"10.13039\/100008397","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005747","name":"A.P. M\u00f8ller og Hustru Chastine Mc-Kinney M\u00f8llers Fond til almene Formaal","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005747","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2025,11]]},"abstract":"Abstract<\/jats:title>Purpose<\/jats:title>To examine the association between the presence of dry eye disease (DED<\/jats:styled-content>) symptoms when using BAK<\/jats:styled-content>\u2010preserved artificial tears (AT<\/jats:styled-content>) compared to preservative\u2010free AT<\/jats:styled-content>.<\/jats:p><\/jats:sec>Methods<\/jats:title>In this cross\u2010sectional study, we used data collected as part of Project \u2018Finding Ophthalmic Risk and Evaluating the Value of Eye exams and their predictive Reliability\u2019 (FOREVER<\/jats:styled-content>). To analyse the strength and direction of associations, we used binomial logistic regression models adjusted for age, sex, smoking and eye diseases. The analysis was conducted on responses regarding AT<\/jats:styled-content> formulations and seven distinct DED<\/jats:styled-content> symptoms from 67\u2009951 participants in Project FOREVER<\/jats:styled-content>, including 8039 AT<\/jats:styled-content> users.<\/jats:p><\/jats:sec>Results<\/jats:title>Our analysis showed statistically significant higher odds ratios (ORs<\/jats:styled-content>) of experiencing itching and blurred vision among users of BAK<\/jats:styled-content>\u2010preserved AT<\/jats:styled-content> compared to preservative\u2010free AT<\/jats:styled-content> users, with ORs<\/jats:styled-content> of 1.26 (95% CI<\/jats:styled-content> 1.01\u20131.58) and 1.28 (95% CI<\/jats:styled-content> 1.02\u20131.60), respectively. Additionally, a borderline significant trend indicated an increased number of DED<\/jats:styled-content> symptoms in the BAK<\/jats:styled-content>\u2010preserved AT<\/jats:styled-content> group compared to preservative\u2010free AT<\/jats:styled-content> users. Furthermore, our study provided a comprehensive overview of AT<\/jats:styled-content> usage patterns within the cohort, illustrating the proportion of users for each type of AT<\/jats:styled-content>.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Our findings suggest that BAK<\/jats:styled-content>\u2010preserved AT<\/jats:styled-content> may worsen DED<\/jats:styled-content> symptoms. We found higher ORs<\/jats:styled-content> for experiencing itching and blurred vision as well as a tendency towards experiencing a higher number of symptoms when using BAK<\/jats:styled-content>\u2010preserved AT<\/jats:styled-content> compared to preservative\u2010free AT<\/jats:styled-content>. Further longitudinal studies with additional questions on AT<\/jats:styled-content> usage and clinical assessments are needed to validate these findings and optimize AT<\/jats:styled-content> formulations for safer, effective DED<\/jats:styled-content> management.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.17500","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T03:35:03Z","timestamp":1745292903000},"page":"823-830","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Preservatives in artificial tears: Assessing impact on dry eye symptoms"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9063-4188","authenticated-orcid":false,"given":"Astrid Dissing","family":"Sj\u00f6","sequence":"first","affiliation":[{"name":"Department of Drug Design and Pharmacology University of Copenhagen Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4114-0267","authenticated-orcid":false,"given":"Jens","family":"Rovelt","sequence":"additional","affiliation":[{"name":"Department of Drug Design and Pharmacology University of Copenhagen Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Ahrenberg","sequence":"additional","affiliation":[{"name":"Department of Drug Design and Pharmacology University of Copenhagen Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8697-0734","authenticated-orcid":false,"given":"Miriam","family":"Kolko","sequence":"additional","affiliation":[{"name":"Department of Drug Design and Pharmacology University of Copenhagen Copenhagen Denmark"},{"name":"Department of Ophthalmology Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1076\/ceyr.22.1.8.6977"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.preteyeres.2010.03.001"},{"key":"e_1_2_9_4_1","first-page":"851","article-title":"Hyperosmolarity potentiates toxic effects of benzalkonium chloride on conjunctival epithelial cells in\u00a0vitro","volume":"18","author":"Clouzeau C.","year":"2012","journal-title":"Molecular Vision"},{"issue":"1","key":"e_1_2_9_5_1","first-page":"2","article-title":"Preservatives from the eye drops and the ocular surface","volume":"59","author":"Coroi M.C.","year":"2015","journal-title":"Romanian Journal of Ophthalmology"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/aos.15693"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161\u20106420(92)31879\u20102"},{"key":"e_1_2_9_8_1","unstructured":"Golden M.I. Meyer J.J. Zeppieri M.&Patel B.C.(2024)Dry eye syndrome."},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41433\u2010021\u201001668\u2010x"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2017.05.004"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.optom.2023.100481"},{"key":"e_1_2_9_12_1","unstructured":"Heegaard S. Knudsen L.L.&vanSetten G.(2022)Dry eye disease nordic guidelines Second edition."},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2017.05.006"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2023.05.012"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23052434"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.2147\/OPTH.S160053"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2017.05.005"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/NHH.0000000000000652"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/781683"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.2147\/OPTH.S228838"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2017.05.003"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1542\u20100124(12)70082\u20104"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2016.09.003"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40135\u2010013\u20100009\u20101"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2016.11.009"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.2147\/OPTH.S211611"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000022234"}],"container-title":["Acta Ophthalmologica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aos.17500","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T12:47:44Z","timestamp":1760705264000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aos.17500"}},"subtitle":["Findings from 67\u2009951 questionnaire responses\u2014Project FOREVER<\/scp>"],"short-title":[],"issued":{"date-parts":[[2025,4,22]]},"references-count":26,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1111\/aos.17500"],"URL":"https:\/\/doi.org\/10.1111\/aos.17500","archive":["Portico"],"relation":{},"ISSN":["1755-375X","1755-3768"],"issn-type":[{"value":"1755-375X","type":"print"},{"value":"1755-3768","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,22]]},"assertion":[{"value":"2024-12-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}