Study Limitations
Interpretation of this study should consider that AT compliance was participant-reported and not actively monitored (i.e., checking empty vials) as other studies have done.Although the objective of this study was to identify effects of CMC on the OSM, neither pure CMC solution nor a perfect control were available. Instead, commercially available ATs were chosen, with different inactive ingredients such as ionic salt buffers, organic (Aminomethylpropanol) salt buffers, hyaluronate, and sorbitol. Although these differences may confound results, their concentration is relatively low. Participants were also compared by time point with no differences in OSM diversity, suggesting that the impacts of these ingredients are not significant confounding factors.Interpretation of these microbiome results should consider that this was a bilateral pooled, anesthetized, and deep conjunctival swab with nylon flocking. The bacterial microbiome at the lid margin may be different from the inferior fornix, and samples may also be affected by anesthesia and swab type.