# Medical-grade manuka honey × MGD dry-eye signs: formulation-specific staining and meibomian signals Verdict 3016 · Evidence Check Stored-material review date: Not recorded Original evidence cut-off: 2026-09-07 Review-criteria version: 1.0 Public page/material preparation date: 2026-10-21 Clinical papers were not read directly; existing review summaries were checked. No new clinical-literature search was performed. Unverified does not mean that research is absent or that there is no effect. ## Assessment scope - Population: Evaporative dry eye from meibomian gland dysfunction. Detailed diagnosis, severity, baseline status, eligibility and group composition remain unverified. - Ingredient, formulation and route: Medical-grade 16% manuka-honey drops or 98% gel were added to existing lid care. Formulations are distinguished from each other and from food-grade or nonsterile products. - Dose: 16% and 98% are concentrations of different formulations. Actual instilled amount, frequency, adherence and exposure remain unverified; concentration is not converted into administered dose. - Comparator: Common warm compresses, lid massage and preservative-free lubricant in the 2017 trial are distinguished from comparison with regular lubricant in the 2021 trial. Details of matched group care and changes remain unverified. - Measured outcome: Staining with 16% drops P=.035 and meibum quality P=.005 and gland expressibility P=.042 with 98% gel are distinguished by formulation and sign. Supporting-trial within-group SPEED results are not sign estimates. - Duration: The principal direct trial over 8 weeks is distinguished from the supporting trial over 3 weeks. Sign signals are not converted into permanent gland recovery or long-term effects; post-stopping durability and long-term harms remain unverified. - Questions outside this scope: Selected-signs C and absent individual score are distinguished from parent C46, symptom C and food-honey self-instillation F. Parent score or axes are not newly inherited.; 16% drops and 98% gel are not combined, and medical-grade sterile products are not expanded into evidence for food-grade, nonsterile or homemade-dilution instillation.; Staining P=.035, meibum quality P=.005 and gland expressibility P=.042 are selected signals linked to their respective formulations and signs. They are not combined into one formulation, scale or overall effect.; SPEED 2.53 points P=.006 and 1.087 points P=.183 are within-group symptom records from the supporting trial. They are not converted into sign estimates, direct between-group symptom effects, new differences or CIs.; 114 participants and 59 randomized with 55 completed are distinguished without calculating new attrition counts, group, eye, patient or safety denominators, or incidence.; Shared reports are not counted as new independent replication for each question. Short-term symptoms and signs are not expanded into long-term recovery, treatment replacement or overall safety. ## Checklist items ### N01 · Which signs question does this evidence check cover? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The existing selected question is improvement in selected staining or meibomian signs. The original account of formulation-specific signals from a small open multiple-outcome trial is retained. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Selected findings are not expanded into all signs or symptom effects. Original formulation, sign, control and time-specific tables, denominators and CIs require additional material. - Required materials and conditions: Formulation-specific comparisons for improvement in selected staining and meibomian signs - Materials to obtain first: Selected findings are not expanded into all signs or symptom effects. Original formulation, sign, control and time-specific tables, denominators and CIs require additional material. - Further research: Material needed: Selected findings are not expanded into all signs or symptom effects. Original formulation, sign, control and time-specific tables, denominators and CIs require additional material. This records needed materials; no new research was executed. - Conditions for verification: Original material on Formulation-specific comparisons for improvement in selected staining and meibomian signs must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Formulation-specific comparisons for improvement in selected staining and meibomian signs is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N02 · What does the staining signal with 16% drops represent? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The principal trial records staining with drops P=.035 as a selected between-group signal. Exact staining effects, scales and CIs are absent from the stored summary. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Original staining sites, scales, assessors, time points, groups, denominators, effects and CIs remain unverified. The value is not converted into a symptom or gel result. - Required materials and conditions: Staining measurement with drops, between-group estimates, P values and CIs - Materials to obtain first: Original staining sites, scales, assessors, time points, groups, denominators, effects and CIs remain unverified. The value is not converted into a symptom or gel result. - Further research: Material needed: Original staining sites, scales, assessors, time points, groups, denominators, effects and CIs remain unverified. The value is not converted into a symptom or gel result. This records needed materials; no new research was executed. - Conditions for verification: Original material on Staining measurement with drops, between-group estimates, P values and CIs must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Staining measurement with drops, between-group estimates, P values and CIs is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N03 · What is the meibum quality signal with 98% gel? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The original principal trial records gel meibum quality P=.005. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: The same value is not copied to staining, gland expressibility or all signs. Grades, scales, assessment, expression methods, groups, denominators, time points, effects and CIs remain unverified. - Required materials and conditions: The definition, assessment, between-group effect, P values and CIs for gel meibum quality - Materials to obtain first: The same value is not copied to staining, gland expressibility or all signs. Grades, scales, assessment, expression methods, groups, denominators, time points, effects and CIs remain unverified. - Further research: Material needed: The same value is not copied to staining, gland expressibility or all signs. Grades, scales, assessment, expression methods, groups, denominators, time points, effects and CIs remain unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on The definition, assessment, between-group effect, P values and CIs for gel meibum quality must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on The definition, assessment, between-group effect, P values and CIs for gel meibum quality is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N04 · What is the gland expressibility signal with 98% gel? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The original principal trial records gel gland expressibility P=.042. It is retained as a separate sign from meibum quality. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Gland selection, measurement, grades, assessors, groups, time points, denominators, effects and CIs remain unverified. New differences are not calculated. - Required materials and conditions: Gland expressibility scales, measurement, between-group effects, P values and CIs - Materials to obtain first: Gland selection, measurement, grades, assessors, groups, time points, denominators, effects and CIs remain unverified. New differences are not calculated. - Further research: Material needed: Gland selection, measurement, grades, assessors, groups, time points, denominators, effects and CIs remain unverified. New differences are not calculated. This records needed materials; no new research was executed. - Conditions for verification: Original material on Gland expressibility scales, measurement, between-group effects, P values and CIs must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Gland expressibility scales, measurement, between-group effects, P values and CIs is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N05 · How do P values differ from effect size and precision? Verification status: Unverified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The stored summary provides selected P values but does not retain exact formulation-specific effect sizes and intervals. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: P values alone do not newly verify large effects, precision, cure or equivalence. Original formulation-specific estimates, baseline and changes, denominators, variance, CIs and models remain unverified. - Required materials and conditions: Sign-specific between-group estimates, variance and 95% CIs - Materials to obtain first: P values alone do not newly verify large effects, precision, cure or equivalence. Original formulation-specific estimates, baseline and changes, denominators, variance, CIs and models remain unverified. - Further research: Material needed: P values alone do not newly verify large effects, precision, cure or equivalence. Original formulation-specific estimates, baseline and changes, denominators, variance, CIs and models remain unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on Sign-specific between-group estimates, variance and 95% CIs must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Sign-specific between-group estimates, variance and 95% CIs is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N06 · Are improvement in all groups and added sign effects distinguished? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: Improvement in all groups is the common-care context. Selected between-group sign signals and before-and-after improvement within each group are retained separately. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Overall recovery is not assigned to honey as an ingredient. Common care, formulation-specific baselines, time points, all results and between-group contrast tables remain unverified. - Required materials and conditions: Direct comparison conditions for each formulation and sign versus common care - Materials to obtain first: Overall recovery is not assigned to honey as an ingredient. Common care, formulation-specific baselines, time points, all results and between-group contrast tables remain unverified. - Further research: Material needed: Overall recovery is not assigned to honey as an ingredient. Common care, formulation-specific baselines, time points, all results and between-group contrast tables remain unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on Direct comparison conditions for each formulation and sign versus common care must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Direct comparison conditions for each formulation and sign versus common care is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N07 · Can drops, gel, staining and gland measures be interchanged? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The original account distinguishes staining with drops from meibomian measures with gel. The 3 P values link to different formulations and measures. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: They are not pooled into a combined effect for one product or scale. Formulations, administration, scales, time points, group denominators and direct superiority comparisons remain unverified; formulation equivalence or superiority is not established. - Required materials and conditions: Matching 16% drop staining to 98% gel quality and expressibility - Materials to obtain first: They are not pooled into a combined effect for one product or scale. Formulations, administration, scales, time points, group denominators and direct superiority comparisons remain unverified; formulation equivalence or superiority is not established. - Further research: Material needed: They are not pooled into a combined effect for one product or scale. Formulations, administration, scales, time points, group denominators and direct superiority comparisons remain unverified; formulation equivalence or superiority is not established. This records needed materials; no new research was executed. - Conditions for verification: Original material on Matching 16% drop staining to 98% gel quality and expressibility must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Matching 16% drop staining to 98% gel quality and expressibility is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N08 · Are assessors and reproducibility of staining and meibum measurement verified? Verification status: Unverified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The original outcome list includes staining and meibum, but methods, scales, assessors and agreement are not detailed. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Successful assessor masking is not newly added to an open trial. Tests, scales, sites, gland selection, assessors, photographs, video, measurement records and time points remain unverified. - Required materials and conditions: Original measurement, expression, assessment sites, scales and masking methods - Materials to obtain first: Successful assessor masking is not newly added to an open trial. Tests, scales, sites, gland selection, assessors, photographs, video, measurement records and time points remain unverified. - Further research: Material needed: Successful assessor masking is not newly added to an open trial. Tests, scales, sites, gland selection, assessors, photographs, video, measurement records and time points remain unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on Original measurement, expression, assessment sites, scales and masking methods must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Original measurement, expression, assessment sites, scales and masking methods is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N09 · How do the open 3-group design, multiple outcomes and selected signals relate? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The original selected explanation and principal report retain the limitation of a small open multiple-outcome trial. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Selected positive P values do not establish prespecified primary-outcome success or positive findings for all outcomes. Registration, protocols, analysis plans, all result tables and multiplicity remain unverified; no new official risk assessment is created. - Required materials and conditions: Prespecified primary outcomes, multiple signs and time points, and multiplicity plans - Materials to obtain first: Selected positive P values do not establish prespecified primary-outcome success or positive findings for all outcomes. Registration, protocols, analysis plans, all result tables and multiplicity remain unverified; no new official risk assessment is created. - Further research: Material needed: Selected positive P values do not establish prespecified primary-outcome success or positive findings for all outcomes. Registration, protocols, analysis plans, all result tables and multiplicity remain unverified; no new official risk assessment is created. This records needed materials; no new research was executed. - Conditions for verification: Original material on Prespecified primary outcomes, multiple signs and time points, and multiplicity plans must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Prespecified primary outcomes, multiple signs and time points, and multiplicity plans is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N10 · Does the supporting trial's signs list also provide exact effects? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The supporting trial's outcomes are 3-week SPEED, tear film, inflammation and staining. The stored result values are within-group SPEED changes. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: SPEED values or P values are not copied into sign results. Original sign-specific results, time points, denominators, formulation, hierarchy, between-group effects and CIs remain unverified. - Required materials and conditions: Tear-film, inflammation and staining results from the 59-participant trial - Materials to obtain first: SPEED values or P values are not copied into sign results. Original sign-specific results, time points, denominators, formulation, hierarchy, between-group effects and CIs remain unverified. - Further research: Material needed: SPEED values or P values are not copied into sign results. Original sign-specific results, time points, denominators, formulation, hierarchy, between-group effects and CIs remain unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on Tear-film, inflammation and staining results from the 59-participant trial must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Tear-film, inflammation and staining results from the 59-participant trial is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N11 · Are symptom superiority and sign signals different questions? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The parent and symptom question retain a gap in direct between-group symptom effects. Selected sign signals do not become symptom verification or new independent trials. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Original symptom and sign tables, denominators, scales and matching within the same cohort remain unverified. Shared reports across the questions are not counted as separate independent replication. - Required materials and conditions: The boundary of direct results for selected signs and the symptom question - Materials to obtain first: Original symptom and sign tables, denominators, scales and matching within the same cohort remain unverified. Shared reports across the questions are not counted as separate independent replication. - Further research: Material needed: Original symptom and sign tables, denominators, scales and matching within the same cohort remain unverified. Shared reports across the questions are not counted as separate independent replication. This records needed materials; no new research was executed. - Conditions for verification: Original material on The boundary of direct results for selected signs and the symptom question must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on The boundary of direct results for selected signs and the symptom question is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N12 · Do tear film, colonization and lubricant use share the same effect? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The principal trial's outcome list also includes tear film, colonization and lubricant use. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: The selected 3 P values are not used as effects on remaining outcomes, clinical symptoms or infection prevention. Each original outcome, hierarchy, value, denominator and between-group contrast remains unverified; unrecorded effects or CIs are not created. - Required materials and conditions: Separate outcomes for other ocular-surface measures, mechanisms and medication use - Materials to obtain first: The selected 3 P values are not used as effects on remaining outcomes, clinical symptoms or infection prevention. Each original outcome, hierarchy, value, denominator and between-group contrast remains unverified; unrecorded effects or CIs are not created. - Further research: Material needed: The selected 3 P values are not used as effects on remaining outcomes, clinical symptoms or infection prevention. Each original outcome, hierarchy, value, denominator and between-group contrast remains unverified; unrecorded effects or CIs are not created. This records needed materials; no new research was executed. - Conditions for verification: Original material on Separate outcomes for other ocular-surface measures, mechanisms and medication use must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Separate outcomes for other ocular-surface measures, mechanisms and medication use is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N13 · How are the principal 8 weeks, supporting 3 weeks and long-term recovery distinguished? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The original principal direct trial spans 8 weeks and the supporting trial 3 weeks. Durations from different reports are distinguished. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Sign signals are not expanded into permanent gland recovery or long-term durability. Report-specific sign time points, administration, long-term and post-stopping course and direct results remain unverified. - Required materials and conditions: Sign-specific time points, exposure, post-stopping and long-term follow-up - Materials to obtain first: Sign signals are not expanded into permanent gland recovery or long-term durability. Report-specific sign time points, administration, long-term and post-stopping course and direct results remain unverified. - Further research: Material needed: Sign signals are not expanded into permanent gland recovery or long-term durability. Report-specific sign time points, administration, long-term and post-stopping course and direct results remain unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on Sign-specific time points, exposure, post-stopping and long-term follow-up must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Sign-specific time points, exposure, post-stopping and long-term follow-up is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N14 · How are medical-grade sterile products distinguished from food honey? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The original record concerns ophthalmic medical-grade products, not evidence for food-grade manuka honey or homemade dilution. Concentration differs from actual instilled amount and frequency. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Product, sterility, ingredients, manufacture, dose, frequency and administration records remain unverified in detail. Medical-grade product records are not expanded into effects of food-grade or nonsterile products. - Required materials and conditions: Manufacture, quality and actual administration of medical-grade 16% drops and 98% gel - Materials to obtain first: Product, sterility, ingredients, manufacture, dose, frequency and administration records remain unverified in detail. Medical-grade product records are not expanded into effects of food-grade or nonsterile products. - Further research: Material needed: Product, sterility, ingredients, manufacture, dose, frequency and administration records remain unverified in detail. Medical-grade product records are not expanded into effects of food-grade or nonsterile products. This records needed materials; no new research was executed. - Conditions for verification: Original material on Manufacture, quality and actual administration of medical-grade 16% drops and 98% gel must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Manufacture, quality and actual administration of medical-grade 16% drops and 98% gel is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N15 · What was added to common lid care? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: In 2017, all groups used common warm compresses, lid massage and preservative-free lubricant. The comparison added medical-grade honey products to that care. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: It is not converted into evidence for stopping care or standalone treatment. Common-care rules, adherence, additional and rescue medications, formulation-specific matching and changes remain unverified. - Required materials and conditions: Warm compresses, massage, preservative-free lubricant and formulation-specific additional care - Materials to obtain first: It is not converted into evidence for stopping care or standalone treatment. Common-care rules, adherence, additional and rescue medications, formulation-specific matching and changes remain unverified. - Further research: Material needed: It is not converted into evidence for stopping care or standalone treatment. Common-care rules, adherence, additional and rescue medications, formulation-specific matching and changes remain unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on Warm compresses, massage, preservative-free lubricant and formulation-specific additional care must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Warm compresses, massage, preservative-free lubricant and formulation-specific additional care is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N16 · Are MGD diagnosis and sample size the same information? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The parent question concerns evaporative dry eye from meibomian gland dysfunction. 114 participants is the original sample-size label. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Sample size does not replace diagnostic or eligibility criteria. Diagnosis, severity, baseline symptoms and signs, age, comorbidities and group-specific inclusion and exclusion remain unverified. - Required materials and conditions: Diagnosis, severity, baseline status and group-specific eligibility in evaporative dry eye - Materials to obtain first: Sample size does not replace diagnostic or eligibility criteria. Diagnosis, severity, baseline symptoms and signs, age, comorbidities and group-specific inclusion and exclusion remain unverified. - Further research: Material needed: Sample size does not replace diagnostic or eligibility criteria. Diagnosis, severity, baseline symptoms and signs, age, comorbidities and group-specific inclusion and exclusion remain unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on Diagnosis, severity, baseline status and group-specific eligibility in evaporative dry eye must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Diagnosis, severity, baseline status and group-specific eligibility in evaporative dry eye is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N17 · What are the selected-sign denominators in 114 participants and 3 groups? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The principal trial's sample was 114 participants and its design was an open 3-group randomized trial. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Group allocation, completion, formulations, care groups, endpoints, time points, bilateral-eye and patient denominators and exclusions remain unverified. Denominators absent from the original are not created. - Required materials and conditions: Group allocation, completion, analysis and endpoint-specific eye and patient denominators - Materials to obtain first: Group allocation, completion, formulations, care groups, endpoints, time points, bilateral-eye and patient denominators and exclusions remain unverified. Denominators absent from the original are not created. - Further research: Material needed: Group allocation, completion, formulations, care groups, endpoints, time points, bilateral-eye and patient denominators and exclusions remain unverified. Denominators absent from the original are not created. This records needed materials; no new research was executed. - Conditions for verification: Original material on Group allocation, completion, analysis and endpoint-specific eye and patient denominators must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Group allocation, completion, analysis and endpoint-specific eye and patient denominators is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N18 · What denominators are 59 randomized and 55 completed? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The supporting trial originally recorded 59 randomized and 55 completed. These values describe separate stages. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Attrition counts or group-specific and endpoint-specific analysis denominators are not calculated or established. Group flow, reasons, time points and eye and patient denominators remain unverified. - Required materials and conditions: Supporting-trial allocation, completion, analysis and group, eye and patient endpoint denominators - Materials to obtain first: Attrition counts or group-specific and endpoint-specific analysis denominators are not calculated or established. Group flow, reasons, time points and eye and patient denominators remain unverified. - Further research: Material needed: Attrition counts or group-specific and endpoint-specific analysis denominators are not calculated or established. Group flow, reasons, time points and eye and patient denominators remain unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on Supporting-trial allocation, completion, analysis and group, eye and patient endpoint denominators must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Supporting-trial allocation, completion, analysis and group, eye and patient endpoint denominators is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N19 · What is the impact of missingness, attrition and measurement exclusions? Verification status: Unverified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: Overall sample and completion records exist, but endpoint-specific missingness, attrition reasons and analysis conditions are not detailed. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Unread external material is not converted into absence of missingness. Missingness, stopping, exclusions, ITT and completer analyses, missing-data handling, sensitivity and group and eye matching remain unverified. - Required materials and conditions: Group flow, missing selected-sign outcomes, analysis populations and sensitivity analyses - Materials to obtain first: Unread external material is not converted into absence of missingness. Missingness, stopping, exclusions, ITT and completer analyses, missing-data handling, sensitivity and group and eye matching remain unverified. - Further research: Material needed: Unread external material is not converted into absence of missingness. Missingness, stopping, exclusions, ITT and completer analyses, missing-data handling, sensitivity and group and eye matching remain unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on Group flow, missing selected-sign outcomes, analysis populations and sensitivity analyses must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Group flow, missing selected-sign outcomes, analysis populations and sensitivity analyses is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N20 · What were the baseline adjustment, change and testing conditions? Verification status: Unverified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: Original P values and selected changes are retained, but detailed adjustment, variance, time points, denominators and effects of interest remain unread in external originals. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Original analysis plans, statistical tables, baseline and changes, within-eye and within-person correlation, models and CIs remain unverified. New effects or CIs are not back-calculated. - Required materials and conditions: The effect of interest, baseline adjustment, change and final values, and variance - Materials to obtain first: Original analysis plans, statistical tables, baseline and changes, within-eye and within-person correlation, models and CIs remain unverified. New effects or CIs are not back-calculated. - Further research: Material needed: Original analysis plans, statistical tables, baseline and changes, within-eye and within-person correlation, models and CIs remain unverified. New effects or CIs are not back-calculated. This records needed materials; no new research was executed. - Conditions for verification: Original material on The effect of interest, baseline adjustment, change and final values, and variance must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on The effect of interest, baseline adjustment, change and final values, and variance is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N21 · Does a registration number also verify prespecified plans? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: Registration was unverified for the principal trial, while NCT04457648 was recorded for the supporting trial. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: The number's existence is not promoted into registration reading in this work, prespecification, hierarchy at all time points or plan adherence. Official registration history, protocols and analysis plans were unread in this work. - Required materials and conditions: Registration, history, primary outcomes, changes and original plans for both trials - Materials to obtain first: The number's existence is not promoted into registration reading in this work, prespecification, hierarchy at all time points or plan adherence. Official registration history, protocols and analysis plans were unread in this work. - Further research: Material needed: The number's existence is not promoted into registration reading in this work, prespecification, hierarchy at all time points or plan adherence. Official registration history, protocols and analysis plans were unread in this work. This records needed materials; no new research was executed. - Conditions for verification: Original material on Registration, history, primary outcomes, changes and original plans for both trials must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Registration, history, primary outcomes, changes and original plans for both trials is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N22 · Do parent and subquestions share the same reports? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The parent and subquestions share the same Albietz 2017 and Wong 2021 reports. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Sheet counts are not counted as new studies or independent replications. Report, trial, registration, sample, institution, timing and additional-report matching and unique trial and participant totals remain unverified. - Required materials and conditions: Report, trial and participant links between the symptom question and other questions - Materials to obtain first: Sheet counts are not counted as new studies or independent replications. Report, trial, registration, sample, institution, timing and additional-report matching and unique trial and participant totals remain unverified. - Further research: Material needed: Sheet counts are not counted as new studies or independent replications. Report, trial, registration, sample, institution, timing and additional-report matching and unique trial and participant totals remain unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on Report, trial and participant links between the symptom question and other questions must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Report, trial and participant links between the symptom question and other questions is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N23 · Is independent replication across teams, products and formulations verified? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The bibliographies of both reports retain an Albietz author and the specific Optimel product context. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Different reports or assessor masking alone do not newly establish independent teams or replication under the same conditions. Team, institution, product, funding, participant, effect and denominator matching remain unverified. - Required materials and conditions: Unique trials and independent teams for the same selected signs, formulation, population, comparison and time point - Materials to obtain first: Different reports or assessor masking alone do not newly establish independent teams or replication under the same conditions. Team, institution, product, funding, participant, effect and denominator matching remain unverified. - Further research: Material needed: Different reports or assessor masking alone do not newly establish independent teams or replication under the same conditions. Team, institution, product, funding, participant, effect and denominator matching remain unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on Unique trials and independent teams for the same selected signs, formulation, population, comparison and time point must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Unique trials and independent teams for the same selected signs, formulation, population, comparison and time point is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N24 · How much is known about product provision and company involvement? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The principal trial records Optimel product provision and related involvement; the supporting trial records a specific Optimel product, provision and author conflict disclosure. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Unrecorded funding, employee relationships, analysis and publication roles remain unverified. Product provision is not treated as verification of every involvement route or as absence of independence. - Required materials and conditions: Trial-specific funding, product support, employee authors and conflicts - Materials to obtain first: Unrecorded funding, employee relationships, analysis and publication roles remain unverified. Product provision is not treated as verification of every involvement route or as absence of independence. - Further research: Material needed: Unrecorded funding, employee relationships, analysis and publication roles remain unverified. Product provision is not treated as verification of every involvement route or as absence of independence. This records needed materials; no new research was executed. - Conditions for verification: Original material on Trial-specific funding, product support, employee authors and conflicts must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Trial-specific funding, product support, employee authors and conflicts is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N25 · What is the scope of reported stinging and redness? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The original record reports temporary stinging and redness and cautions that initial symptoms are possible even with medical-grade formulations. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Event counts, incidence or new causality are not created. Collection methods, group and formulation-specific events, severity, timing, stopping, missingness and controls remain unverified. - Required materials and conditions: Medical-grade product adverse reactions, collection methods, stopping and controls - Materials to obtain first: Event counts, incidence or new causality are not created. Collection methods, group and formulation-specific events, severity, timing, stopping, missingness and controls remain unverified. - Further research: Material needed: Event counts, incidence or new causality are not created. Collection methods, group and formulation-specific events, severity, timing, stopping, missingness and controls remain unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on Medical-grade product adverse reactions, collection methods, stopping and controls must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Medical-grade product adverse reactions, collection methods, stopping and controls is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N26 · What are the eye and patient harm denominators and exposures? Verification status: Unverified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: 114 participants, 59 randomized and 55 completed do not verify safety denominators. Concentrations, formulations, 3 and 8 weeks and common care are not combined as the same harm exposure. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Safety denominators, actual instillation, group, eye and formulation-specific events, stopping, exposure and controls remain unverified. Incidence is not calculated. - Required materials and conditions: Safety populations, eyes, patients, formulations, durations and actual instillation exposure - Materials to obtain first: Safety denominators, actual instillation, group, eye and formulation-specific events, stopping, exposure and controls remain unverified. Incidence is not calculated. - Further research: Material needed: Safety denominators, actual instillation, group, eye and formulation-specific events, stopping, exposure and controls remain unverified. Incidence is not calculated. This records needed materials; no new research was executed. - Conditions for verification: Original material on Safety populations, eyes, patients, formulations, durations and actual instillation exposure must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Safety populations, eyes, patients, formulations, durations and actual instillation exposure is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N27 · Are food or nonsterile risks distinguished from medical-grade product reactions? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The original caution distinguishes infection and corneal-injury risks with food-grade, nonsterile and homemade dilutions from initial stinging and redness with medical-grade products. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: The food-honey self-instillation question is distinguished and no new case is created. Products, baseline eye conditions, concurrent use, event timing, alternative causes, controls and course remain unverified; no new harm causality is judged. - Required materials and conditions: Manufacture, sterility, baseline eye conditions, other causes and clinical course - Materials to obtain first: The food-honey self-instillation question is distinguished and no new case is created. Products, baseline eye conditions, concurrent use, event timing, alternative causes, controls and course remain unverified; no new harm causality is judged. - Further research: Material needed: The food-honey self-instillation question is distinguished and no new case is created. Products, baseline eye conditions, concurrent use, event timing, alternative causes, controls and course remain unverified; no new harm causality is judged. This records needed materials; no new research was executed. - Conditions for verification: Original material on Manufacture, sterility, baseline eye conditions, other causes and clinical course must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Manufacture, sterility, baseline eye conditions, other causes and clinical course is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N28 · Are long-term, rare and vulnerable-population harms verified? Verification status: Unverified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: Small short-term trials of specific products and descriptions of temporary reactions do not verify long-term, rare or vulnerable-population safety. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: Long follow-up, independent harm reports, vulnerable populations, exposure, denominators, concurrent use and course remain unverified. No external search or new harm judgment was performed in this work. - Required materials and conditions: Long exposure, independent harm reports, vulnerable populations and follow-up - Materials to obtain first: Long follow-up, independent harm reports, vulnerable populations, exposure, denominators, concurrent use and course remain unverified. No external search or new harm judgment was performed in this work. - Further research: Material needed: Long follow-up, independent harm reports, vulnerable populations, exposure, denominators, concurrent use and course remain unverified. No external search or new harm judgment was performed in this work. This records needed materials; no new research was executed. - Conditions for verification: Original material on Long exposure, independent harm reports, vulnerable populations and follow-up must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on Long exposure, independent harm reports, vulnerable populations and follow-up is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N29 · How does stored-summary reading differ from reading external originals? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The complete parent Korean and English summary, reports and citations were read. PubMed URLs and registration numbers are existing records; external abstracts, full texts, registration, protocols and analysis plans were unread in this work. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: URLs, numbers and historical verification wording do not establish current reading, successful access or fulfilled conditions. External detailed-material availability, acquisition and actual reading remain separately unverified. - Required materials and conditions: The complete stored summary and the reading scope for external abstracts, full texts, registration and plans - Materials to obtain first: URLs, numbers and historical verification wording do not establish current reading, successful access or fulfilled conditions. External detailed-material availability, acquisition and actual reading remain separately unverified. - Further research: Material needed: URLs, numbers and historical verification wording do not establish current reading, successful access or fulfilled conditions. External detailed-material availability, acquisition and actual reading remain separately unverified. This records needed materials; no new research was executed. - Conditions for verification: Original material on The complete stored summary and the reading scope for external abstracts, full texts, registration and plans must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on The complete stored summary and the reading scope for external abstracts, full texts, registration and plans is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ### N30 · What do selected C, parent C46, dates and empty values record? Verification status: Partly verified Reading scope: Complete stored parent Korean and English summary, selected question and bibliography read; external abstracts, full text, registration, protocols and analysis plans unread - Current findings: The selected grade is C, with no individual score, status or axes fields. Parent C46, caution, axes, Korean and English records, 2026-09-07 and empty correction and deliberation records are preserved separately. - Why unverified: This state links partial information and gaps in the preserved selected and parent accounts. External verification and clinical content review remain incomplete; it does not certify fulfilled conditions, efficacy, safety, prespecification or independence. - Reason for missing information: The parent's 46 points are not assigned as a subclaim score, and the historical evidence date is not changed into a new search, external reading or completed-review date. New material, condition revisions and verdict changes are separate events. - Required materials and conditions: The selected grade, absent individual score, parent axes, evidence date and corrections - Materials to obtain first: The parent's 46 points are not assigned as a subclaim score, and the historical evidence date is not changed into a new search, external reading or completed-review date. New material, condition revisions and verdict changes are separate events. - Further research: Material needed: The parent's 46 points are not assigned as a subclaim score, and the historical evidence date is not changed into a new search, external reading or completed-review date. New material, condition revisions and verdict changes are separate events. This records needed materials; no new research was executed. - Conditions for verification: Original material on The selected grade, absent individual score, parent axes, evidence date and corrections must link to the same question, control, endpoint, time point and denominators, distinguishing within- and between-group results, parent context and unread external materials. - Why this condition is needed: Material on The selected grade, absent individual score, parent axes, evidence date and corrections is needed to connect the medical-grade product, formulation-specific sign, existing care, population, comparison, measurement, time point, eye and patient denominators, precision and harms. - Application exceptions: Selected-signs C and absent individual score, status and axes are retained, distinguishing parent C46, symptom C and food-honey self-instillation F. Formulations, signs and P values are not combined or converted into symptoms or long-term recovery. Supporting within-group SPEED values are not transferred to signs or between-group symptom effects. No new effects, CIs, differences, attrition counts, incidence, denominators, unique totals, grades or individual-care guidance are created. - Remaining uncertainty: Exact formulation-specific sign effects, CIs, scales, measurement and reproducibility, group and eye denominators, baseline adjustment, missingness, prespecified hierarchy, exposure, independence, long-term effects and harms remain unverified. Original P values and historical verification wording are not promoted into new calculations, current external reading or completed clinical review. - Referenced methods: Preserved principles distinguishing questions, direct comparisons, reports and trials, endpoints, denominators, precision and harms informed production. - Related sources: R01, R02 ## Evidence and sources ### R01 Albietz JM·Lenton LM. 2017 [PubMed](https://pubmed.ncbi.nlm.nih.gov/28585260/) Materials actually read: The complete stored parent Korean and English summary, original reports and citations were read. External abstracts, full texts, registration, protocols and analysis plans were unread in this work. Findings recorded in the summary: The original comparison in 114 participants added 16% drops or 98% gel to common care. All groups improved; selected sign signals included staining with drops P=.035 and gel meibum quality P=.005 and gland expressibility P=.042. Record level: These are selected formulation-specific sign signals from the principal open multiple-outcome trial. The original principal duration is 8 weeks; exact sign effects, CIs, scales, measurement, eye and patient denominators and prespecified hierarchy remain unverified. Symptom superiority, formulation superiority and permanent gland recovery are not established. Independent replication: Parent 3016 and the symptom and selected-sign questions share 2 reports, Albietz 2017 and Wong 2021. Shared authors and the specific Optimel product context are retained, while exact sample overlap, unique trial and participant totals and independent replication remain unverified. | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Stored existing review summary | Preserved copy of the complete parent-verdict stored summary | Stored summary | Summary read | PMID28585260, DOI10.1111/cxo.12524 and the original record of Optimel product provision and related involvement are retained. Registration details, product contracts, funding and author roles are unread externally; unverified information is not converted into absence. The stored-summary material date 2026-10-06T13:02:14.262787+09:00 is an original production record; unread external material dates are empty. The historical evidence date 2026-09-07 is distinguished from this publication, external reading or completed clinical review. | | External abstract | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | PMID28585260, DOI10.1111/cxo.12524 and the original record of Optimel product provision and related involvement are retained. Registration details, product contracts, funding and author roles are unread externally; unverified information is not converted into absence. The stored-summary material date 2026-10-06T13:02:14.262787+09:00 is an original production record; unread external material dates are empty. The historical evidence date 2026-09-07 is distinguished from this publication, external reading or completed clinical review. | | External full text | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | PMID28585260, DOI10.1111/cxo.12524 and the original record of Optimel product provision and related involvement are retained. Registration details, product contracts, funding and author roles are unread externally; unverified information is not converted into absence. The stored-summary material date 2026-10-06T13:02:14.262787+09:00 is an original production record; unread external material dates are empty. The historical evidence date 2026-09-07 is distinguished from this publication, external reading or completed clinical review. | | Registration material | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | PMID28585260, DOI10.1111/cxo.12524 and the original record of Optimel product provision and related involvement are retained. Registration details, product contracts, funding and author roles are unread externally; unverified information is not converted into absence. The stored-summary material date 2026-10-06T13:02:14.262787+09:00 is an original production record; unread external material dates are empty. The historical evidence date 2026-09-07 is distinguished from this publication, external reading or completed clinical review. | | Protocol and analysis plan | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | PMID28585260, DOI10.1111/cxo.12524 and the original record of Optimel product provision and related involvement are retained. Registration details, product contracts, funding and author roles are unread externally; unverified information is not converted into absence. The stored-summary material date 2026-10-06T13:02:14.262787+09:00 is an original production record; unread external material dates are empty. The historical evidence date 2026-09-07 is distinguished from this publication, external reading or completed clinical review. | ### R02 Wong D et al. 2021 [PubMed](https://pubmed.ncbi.nlm.nih.gov/33419788/) Materials actually read: The complete stored parent Korean and English summary, original reports and citations were read. External abstracts, full texts, registration, protocols and analysis plans were unread in this work. Findings recorded in the summary: 59 randomized and 55 completed were recorded, with 3-week within-group SPEED changes of 2.53 points P=.006 for honey drops and 1.087 points P=.183 for regular lubricant. The stored summary states that the abstract did not present a direct between-group symptom effect. Record level: Tear film, inflammation and staining appear in the supporting trial outcome list, but the original numeric results are within-group SPEED changes. They are not converted into sign effects or direct between-group symptom effects. Assessor masking is not promoted into participant or treatment-provider masking, and new differences, CIs, attrition counts or safety denominators are not calculated. Independent replication: Parent 3016 and the symptom and selected-sign questions share 2 reports, Albietz 2017 and Wong 2021. Shared authors and the specific Optimel product context are retained, while exact sample overlap, unique trial and participant totals and independent replication remain unverified. | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Stored existing review summary | Preserved copy of the complete parent-verdict stored summary | Stored summary | Summary read | PMID33419788, DOI10.1136/bjophthalmol-2020-317506, NCT04457648, specific Optimel product provision and author conflict disclosure are retained. The number does not establish registration reading in this work, prespecification or plan adherence; disclosure details are unread. The stored-summary material date 2026-10-06T13:02:14.262787+09:00 is an original production record; unread external material dates are empty. The historical evidence date 2026-09-07 is distinguished from this publication, external reading or completed clinical review. | | External abstract | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | PMID33419788, DOI10.1136/bjophthalmol-2020-317506, NCT04457648, specific Optimel product provision and author conflict disclosure are retained. The number does not establish registration reading in this work, prespecification or plan adherence; disclosure details are unread. The stored-summary material date 2026-10-06T13:02:14.262787+09:00 is an original production record; unread external material dates are empty. The historical evidence date 2026-09-07 is distinguished from this publication, external reading or completed clinical review. | | External full text | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | PMID33419788, DOI10.1136/bjophthalmol-2020-317506, NCT04457648, specific Optimel product provision and author conflict disclosure are retained. The number does not establish registration reading in this work, prespecification or plan adherence; disclosure details are unread. The stored-summary material date 2026-10-06T13:02:14.262787+09:00 is an original production record; unread external material dates are empty. The historical evidence date 2026-09-07 is distinguished from this publication, external reading or completed clinical review. | | Registration material | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | PMID33419788, DOI10.1136/bjophthalmol-2020-317506, NCT04457648, specific Optimel product provision and author conflict disclosure are retained. The number does not establish registration reading in this work, prespecification or plan adherence; disclosure details are unread. The stored-summary material date 2026-10-06T13:02:14.262787+09:00 is an original production record; unread external material dates are empty. The historical evidence date 2026-09-07 is distinguished from this publication, external reading or completed clinical review. | | Protocol and analysis plan | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | PMID33419788, DOI10.1136/bjophthalmol-2020-317506, NCT04457648, specific Optimel product provision and author conflict disclosure are retained. The number does not establish registration reading in this work, prespecification or plan adherence; disclosure details are unread. The stored-summary material date 2026-10-06T13:02:14.262787+09:00 is an original production record; unread external material dates are empty. The historical evidence date 2026-09-07 is distinguished from this publication, external reading or completed clinical review. | ## Review criteria and methods These are Chamgap's own application conditions, informed by the relevant sections of official methodological guidance. They do not constitute official assessment-tool certification or a new efficacy score. - M03 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03) · §3.1, §3.2.1–3.2.3, MECIR C5/C7/C13 · Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed. - M04 [Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04) · §4.5, §4.6.1–4.6.3, MECIR C42 · Distinguish studies from reports and link them; do not omit a study solely because results are unreported. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed. - M08 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08) · §8.1–8.2.3, Table 8.2.a · Define the outcome and effect of interest, then examine randomization, deviations, missing data, measurement and selective reporting. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed. - M15 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15) · §15.2.4, §15.3.1–15.3.3 · Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed. - M19 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19) · §19.1.2, §19.2.1–19.2.4 · Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed. ## What the statuses mean - Partly verified: Partial information from the stored summary is linked; detailed originals and content review remain incomplete. - Unverified: Required details cannot be established within the preserved scope. This does not establish absence of effects or studies, or safety. - Review incomplete: Review of existing content remains incomplete. - Met: This state is used only within the relevant conditions after material verification and content review. It was not automatically assigned in this work. - Not reported: Unreported within material actually read. Unread external material is not relabeled as unreported. - Inaccessible: This means actual access failure. External access was not attempted in this work, so this state was not assigned. - Not applicable: Used only with an application exception and reason based on the question scope. - Conflicting data: This requires actual comparison of materials; no new conflict judgment was made in this work. - Insufficient evidence for the conditions: This indicates gaps in additional material for the selected conditions. Unread material as a whole is not converted into an efficacy grade. ## Change history 2026-10-21 · Public page/materials 1.0. Public-facing views and materials were prepared from the existing 30 items. No new clinical search, verification-status change or scoring was performed.