Volume 38, October 2025, Pages 390-391Author links open overlay panel, , Section snippetsMethodological transparency

Our analysis was prospectively registered in PROSPERO (CRD42025634572) and conducted according to the PRISMA-NMA 2020 extension. The full electronic search strategies, inclusion criteria, and PRISMA flow diagram were provided in the Supplementary Materials to ensure reproducibility. Two independent reviewers screened studies and extracted data following prespecified PICO parameters.

Scope of clinical conditions and interventions

The NMA was designed to capture the comparative performance of topical pharmacologic interventions across the allergic-conjunctivitis spectrum—seasonal (SAC), perennial (PAC), vernal (VKC), and atopic (AKC). We recognize the pathophysiologic diversity among these entities; therefore, subgroup analyses were performed for each condition type (see Fig. 1, Section 3.8). This stratified approach prevented inappropriate pooling and allowed comparison of therapeutic classes within clinically coherent

Network geometry and consistency

We appreciate the concern regarding network connectivity. The networks were internally connected within each subgroup. In disconnected instances, treatments were analyzed descriptively rather than merged, adhering to Cochrane NMA guidance. Node-splitting and sensitivity analyses confirmed acceptable consistency between direct and indirect evidence (p > 0.05).

Interpretation of SUCRA rankings

We concur that SUCRA rankings are probabilistic indicators, not absolute hierarchies. Our results were presented alongside 95 % CIs and heterogeneity indices to support balanced interpretation. The Discussion explicitly cautioned readers to interpret rankings within clinical context and to consider uncertainty when comparing treatments.

Heterogeneity and study quality

Moderate heterogeneity (I2 ≈ 50 %) was anticipated given variations in trial design and population. We minimized its effect through random-effects modeling, sensitivity analyses excluding high-risk studies, and transparent reporting of risk-of-bias assessments using RoB 2. The diversity of included trials reflects real-world therapeutic complexity in ocular allergy management.

Shared perspective and future directions

We agree that more standardized and stratified RCTs are needed, particularly for severe forms such as VKC and AKC. Our conclusions were not intended as prescriptive guidelines but as an evidence-based overview to assist clinicians while highlighting gaps in existing research. We welcome continued dialogue and collaboration toward more refined, condition-specific NMAs in ophthalmology.

In closing, we thank the correspondents for promoting scientific discussion. We remain committed to

CRediT authorship contribution statement

Luksanaporn Krungkraipetch: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Project administration, Validation, Visualization, Writing – review & editing. Taweelarp Tansavadi: Resources, Software, Supervision. Dechathorn Krungkraipetch: Resources, Software, Supervision.

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