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Brita: In Search Of Winning Strategy Case Solution & Answer

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Brita: In Search Of Winning Strategy Case Solution

Introduction.

The case discusses  BRITA GmbH Company, which is a German Water Filter Company. In the year 1988, the company’s marketing rights were obtained by Clorox Company. The company is one of the leading companies in the industry. It had a  revenue turnover of around 4.39 billion in the year 2005. The company’s operations are spread in about 25 countries and in markets of more than 100 countries around the globe and employ overall 7600 employees. BRITA created PT (Pour-Through) water filters, the product was a success and led the company to obtain around $ 200 million in initial 4 years of its operations. In the year 1999 the company became globally available with around 70% product awareness while in the US about 18% of the US population were using its product. In the year 1990 the company dealt with stiff competition with the increasing competition in the market of water filters and the competitors came up with new products other than BRITA. (Chattopadhyay, 2007)

Problem statement

From the year 1990, the industrial competition for BRITA substantially increased and in  1998 PUR came up with the new product called FM(faucet-mounted) filter, a better alternate to the company’s PT filter (then it was the only product of the company).This new FM filter with its feature to eliminate illness-causing contaminants gave a strong competition to the PT filter that led to an abrupt decline in company’s sales. With the launch of bottled  water in the year 1990,the market of filtered water was changed  overall. The bottled water business grew so fast to the extent of acquiring 8% of the population giving preference to their liquids. The company used and implemented several strategies to recover its  sales but nothing worked.

In this report, we have to present a winning strategy for BRITA to remain and revive its significance in the water filtration industry by  targeting all sources at home, school, office etc. and providing easy access to clean and healthy water to everyone.

In that report we present the present market situation, consumer tendencies and categories and whose aspects need to lie targeted as a part  of a latter strategy. Long-term and momentary techniques or how we will use  them   to revitalize the BRITA brand into people’s minds, instruct  them concerning the value of clean lotus because the fitness then benefits  humans and for that reason increase sales.

Situational analysis

Following are the market segments based on the segmentation study for water consumption.

• Tap traditionalist,
• Weary Tap Satisfied
• Principled Filter Fans,
• Affluent Fridge Followers,
• Assertive Self Improvers,
• and Bottled Water Indulgers.

The reason behind this segmentation was from these groups the majority of people are  willing for water consumption without any contamination. Based on the target market selection criteria the segments that have been selected are Affluent Fridge Followers, Principled Filter Fans and Assertive Self Improvers.

These segments were selected to target because of the beliefs they hold. According to Principled Filter Fans, filter water is healthier than that of tap. According to Affluent Fridge Followers,filtered water is beneficial in controlling weights while in the view of Assertive Self Improvers, greater consumption of water is necessary to maintain health. Filtered water is often preferred for  urban people because they believe it to have huge benefits. The major consumers of water are Assertive Self Improvers, based on the research done, it is said that most people drink water in  their homes.

Answer no. 2

To target only these segments the company would require great time and investment  to persuade peoples’ attitude toward tap water and filtered water. It would have to invest a great amount of capital in the R&D and the marketing campaigns as well.

Since the selected target markets were Affluent Fridge Followers, Principled Filter Fans and Assertive Self Improvers, these would be further divided into two groups based on the time for which the decision marketing strategies are implemented. These groups are

• Short-run strategy
• Long run strategy

For the short run strategy, sales would be proposed to go up by targeting Principled Filter Fans and Assertive Self Improvers because Principled Filter Fans are the most consumers of PT while Assertive Self Improvers are the consumers of mix pitcher and FM (faucet-mounted).

Furthermore, it was observed that as compared to people being out of their homes, they consume most water at their homes. Moreover, it could also be depicted based on  various researches done that this industry has a great potential to grow.

For the long run strategies,the focus of the target is Affluent Fridge Followers, which  includes the people with age after thirty or in their thirties.These people are literate and working and prefer maximum water consumption regularly for healthy life and they would consider consuming at their maximum convenience. It is a very large segment of water consumers and if BRITA is successful at targeting this group effectively then it would help BRITA to secure a larger market size.

Answer no. 3.

A communication strategy of marketing is the strategy of a company to send its message or advertise its brand to the right people at the right plan and at  the right time. In this case, the communication strategy would be to promote and advertise BRITA in the selected target segments because of their maximum preferences for  consuming safe water without any contamination. These segments would want to consume water to increase their health and not to decrease it. The communication channels like television, internet sites, and magazines could be used as a medium to advertise the product to the targeted segments.

In the first step, the company would be working to achieve its product value proposition. It  is a marketing strategy which is related to coming up with new innovations in the company’s product. For the purpose of value creation BRITA could reach out for various innovative steps in their product. Since its initial launch of its filters it had been using the same product with slight changes.  As a part the long-term strategy, BRITA’s main focus would be on value preposition through product innovation by investing much amount of capital in the R&D, this way it would be able to achieve maximum market share by targeting the proposed Affluent Fridge Followers for long-run. This strategy would also help to motivate the current users of BRITA to  continue using their filters and also would make BRITA to target more groups………………………….

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Brita Products Co. Harvard Case Solution & Analysis

Home >> Management Case Studies >> Brita Products Co.

Brita Clorox to skillfully uses a wave of security problems on the water, rising home water (filtered) business from start up to 15% penetration of U.S. households in ten years. The dilemma in the event that there is a period of increasing returns seems to be coming to an end, and the management should use its legacy installed base and strong brand, to take the business forward in a less friendly environment. Students can simulate the connection between the initial demand for the pitchers, and the derived demand for filters to decide where they want to put future investments. "Hide by John Deighton Source: HBS Premier Case Collection 18 pages . Publication Date: August 30, 1999. Prod. #: 500024-PDF-ENG

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Porter Five Forces Analysis for BRITA In Search of a Winning Strategy

Another helpful tool in finding the case solutions is of Porter's Five Forces analysis. This is also a strategic tool that is used to analyse the competitive environment of the industry in which BRITA In Search of a Winning Strategy operates in. Analysis of the industry is important as businesses do not work in isolation in real life, but are affected by the business environment of the industry that they operate in. Harvard Business case studies represent real-life situations, and therefore, an analysis of the industry's competitive environment needs to be carried out to come up with more holistic case study solutions. In Porter's Five Forces analysis, the industry is analysed along 5 dimensions.

• These are the threats that the industry faces due to new entrants.
• It includes the threat of substitute products.
• It includes the bargaining power of buyers in the industry.
• It includes the bargaining power of suppliers in an industry.
• Lastly, the overall rivalry or competition within the industry is analysed.

This tool helps one understand the relative powers of the major players in the industry and its overall competitive dynamics. Actionable and practical solutions can then be developed by keeping these factors into perspective.

PESTEL Analysis of BRITA In Search of a Winning Strategy

Another helpful tool that should be used in finding the case study solutions is the PESTEL analysis. This also looks at the external business environment of the organisation helps in finding case study Analysis to real-life business issues as in HBR cases.

• The PESTEL analysis particularly looks at the macro environmental factors that affect the industry. These are the political, environmental, social, technological, environmental and legal (regulatory) factors affecting the industry.
• Factors within each of these 6 should be listed down, and analysis should be made as to how these affect the organisation under question.
• These factors are also responsible for the future growth and challenges within the industry. Hence, they should be taken into consideration when coming up with the BRITA In Search of a Winning Strategy case solution.

VRIO Analysis of BRITA In Search of a Winning Strategy

This is an analysis carried out to know about the internal strengths and capabilities of BRITA In Search of a Winning Strategy. Under the VRIO analysis, the following steps are carried out:

• The internal resources of BRITA In Search of a Winning Strategy are listed down.
• Each of these resources are assessed in terms of the value it brings to the organization.
• Each resource is assessed in terms of how rare it is. A rare resource is one that is not commonly used by competitors.
• Each resource is assessed whether it could be imitated by competition easily or not.
• Lastly, each resource is assessed in terms of whether the organization can use it to an advantage or not.

The analysis done on the 4 dimensions; Value, Rareness, Imitability, and Organization. If a resource is high on all of these 4, then it brings long-term competitive advantage. If a resource is high on Value, Rareness, and Imitability, then it brings an unused competitive advantage. If a resource is high on Value and Rareness, then it only brings temporary competitive advantage. If a resource is only valuable, then it’s a competitive parity. If it’s none, then it can be regarded as a competitive disadvantage.

Value Chain Analysis of BRITA In Search of a Winning Strategy

The Value chain analysis of BRITA In Search of a Winning Strategy helps in identifying the activities of an organization, and how these add value in terms of cost reduction and differentiation. This tool is used in the case study analysis as follows:

• The firm’s primary and support activities are listed down.
• Identifying the importance of these activities in the cost of the product and the differentiation they produce.
• Lastly, differentiation or cost reduction strategies are to be used for each of these activities to increase the overall value provided by these activities.

Recognizing value creating activities and enhancing the value that they create allow BRITA In Search of a Winning Strategy to increase its competitive advantage.

BCG Matrix of BRITA In Search of a Winning Strategy

The BCG Matrix is an important tool in deciding whether an organization should invest or divest in its strategic business units. The matrix involves placing the strategic business units of a business in one of four categories; question marks, stars, dogs and cash cows. The placement in these categories depends on the relative market share of the organization and the market growth of these strategic business units. The steps to be followed in this analysis is as follows:

• Identify the relative market share of each strategic business unit.
• Identify the market growth of each strategic business unit.
• Place these strategic business units in one of four categories. Question Marks are those strategic business units with high market share and low market growth rate. Stars are those strategic business units with high market share and high market growth rate. Cash Cows are those strategic business units with high market share and low market growth rate. Dogs are those strategic business units with low market share and low growth rate.
• Relevant strategies should be implemented for each strategic business unit depending on its position in the matrix.

The strategies identified from the BRITA In Search of a Winning Strategy BCG matrix and included in the case pdf. These are either to further develop the product, penetrate the market, develop the market, diversification, investing or divesting.

Ansoff Matrix of BRITA In Search of a Winning Strategy

Ansoff Matrix is an important strategic tool to come up with future strategies for BRITA In Search of a Winning Strategy in the case solution. It helps decide whether an organization should pursue future expansion in new markets and products or should it focus on existing markets and products.

• The organization can penetrate into existing markets with its existing products. This is known as market penetration strategy.
• The organization can develop new products for the existing market. This is known as product development strategy.
• The organization can enter new markets with its existing products. This is known as market development strategy.
• The organization can enter into new markets with new products. This is known as a diversification strategy.

The choice of strategy depends on the analysis of the previous tools used and the level of risk the organization is willing to take.

Marketing Mix of BRITA In Search of a Winning Strategy

BRITA In Search of a Winning Strategy needs to bring out certain responses from the market that it targets. To do so, it will need to use the marketing mix, which serves as a tool in helping bring out responses from the market. The 4 elements of the marketing mix are Product, Price, Place and Promotions. The following steps are required to carry out a marketing mix analysis and include this in the case study analysis.

• Analyse the company’s products and devise strategies to improve the product offering of the company.
• Analyse the company’s price points and devise strategies that could be based on competition, value or cost.
• Analyse the company’s promotion mix. This includes the advertisement, public relations, personal selling, sales promotion, and direct marketing. Strategies will be devised which makes use of a few or all of these elements.
• Analyse the company’s distribution and reach. Strategies can be devised to improve the availability of the company’s products.

BRITA In Search of a Winning Strategy Blue Ocean Strategy

The strategies devised and included in the BRITA In Search of a Winning Strategy case memo should have a blue ocean strategy. A blue ocean strategy is a strategy that involves firms seeking uncontested market spaces, which makes the competition of the company irrelevant. It involves coming up with new and unique products or ideas through innovation. This gives the organization a competitive advantage over other firms, unlike a red ocean strategy.

Competitors analysis of BRITA In Search of a Winning Strategy

The PESTEL analysis discussed previously looked at the macro environmental factors affecting business, but not the microenvironmental factors. One of the microenvironmental factors are competitors, which are addressed by a competitor analysis. The Competitors analysis of BRITA In Search of a Winning Strategy looks at the direct and indirect competitors within the industry that it operates in.

• This involves a detailed analysis of their actions and how these would affect the future strategies of BRITA In Search of a Winning Strategy.
• It involves looking at the current market share of the company and its competitors.
• It should compare the marketing mix elements of competitors, their supply chain, human resources, financial strength etc.
• It also should look at the potential opportunities and threats that these competitors pose on the company.

Organisation of the Analysis into BRITA In Search of a Winning Strategy Case Study Solution

Once various tools have been used to analyse the case, the findings of this analysis need to be incorporated into practical and actionable solutions. These solutions will also be the BRITA In Search of a Winning Strategy case answers. These are usually in the form of strategies that the organisation can adopt. The following step-by-step procedure can be used to organise the Harvard Business case solution and recommendations:

• The first step of the solution is to come up with a corporate level strategy for the organisation. This part consists of solutions that address issues faced by the organisation on a strategic level. This could include suggestions, changes or recommendations to the company's vision, mission and its strategic objectives. It can include recommendations on how the organisation can work towards achieving these strategic objectives. Furthermore, it needs to be explained how the stated recommendations will help in solving the main issue mentioned in the case and where the company will stand in the future as a result of these.
• The second step of the solution is to come up with a business level strategy. The HBR case studies may present issues faced by a part of the organisation. For example, the issues may be stated for marketing and the role of a marketing manager needs to be assumed. So, recommendations and suggestions need to address the strategy of the marketing department in this case. Therefore, the strategic objectives of this business unit (Marketing) will be laid down in the solutions and recommendations will be made as to how to achieve these objectives. Similar would be the case for any other business unit or department such as human resources, finance, IT etc. The important thing to note here is that the business level strategy needs to be aligned with the overall corporate strategy of the organisation. For example, if one suggests the organisation to focus on differentiation for competitive advantage as a corporate level strategy, then it can't be recommended for the BRITA In Search of a Winning Strategy Case Study Solution that the business unit should focus on costs.
• The third step is not compulsory but depends from case to case. In some HBR case studies, one may be required to analyse an issue at a department. This issue may be analysed for a manager or employee as well. In these cases, recommendations need to be made for these people. The solution may state that objectives that these people need to achieve and how these objectives would be achieved.

The case study analysis and solution, and BRITA In Search of a Winning Strategy case answers should be written down in the BRITA In Search of a Winning Strategy case memo, clearly identifying which part shows what. The BRITA In Search of a Winning Strategy case should be in a professional format, presenting points clearly that are well understood by the reader.

Alternate solution to the BRITA In Search of a Winning Strategy HBR case study

It is important to have more than one solution to the case study. This is the alternate solution that would be implemented if the original proposed solution is found infeasible or impossible due to a change in circumstances. The alternate solution for BRITA In Search of a Winning Strategy is presented in the same way as the original solution, where it consists of a corporate level strategy, business level strategy and other recommendations.

Implementation of BRITA In Search of a Winning Strategy Case Solution

The case study does not end at just providing recommendations to the issues at hand. One is also required to provide how these recommendations would be implemented. This is shown through a proper implementation framework. A detailed implementation framework helps in distinguishing between an average and an above average case study answer. A good implementation framework shows the proposed plan and how the organisations' resources would be used to achieve the objectives. It also lays down the changes needed to be made as well as the assumptions in the process.

• A proper implementation framework shows that one has clearly understood the case study and the main issue within it.
• It shows that one has been clarified with the HBR fundamentals on the topic.
• It shows that the details provided in the case have been properly analysed.
• It shows that one has developed an ability to prioritise recommendations and how these could be successfully implemented.
• The implementation framework also helps by removing out any recommendations that are not practical or actionable as these could not be implemented. Therefore, the implementation framework ensures that the solution to the BRITA In Search of a Winning Strategy Harvard case is complete and properly answered.

Recommendations and Action Plan for BRITA In Search of a Winning Strategy case analysis

For BRITA In Search of a Winning Strategy, based on the SWOT Analysis, Porter Five Forces Analysis, PESTEL Analysis, VRIO analysis, Value Chain Analysis, BCG Matrix analysis, Ansoff Matrix analysis, and the Marketing Mix analysis, the recommendations and action plan are as follows:

• BRITA In Search of a Winning Strategy should focus on making use of its strengths identified from the VRIO analysis to make the most of the opportunities identified from the PESTEL.
• BRITA In Search of a Winning Strategy should enhance the value creating activities within its value chain.
• BRITA In Search of a Winning Strategy should invest in its stars and cash cows, while getting rid of the dogs identified from the BCG Matrix analysis.
• To achieve its overall corporate and business level objectives, it should make use of the marketing mix tools to obtain desired results from its target market.

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Using 2% PVPI topical solution for serial intravitreous injections and ocular surface findings: a case control study

• José Henrique Casemiro 1 ,
• Ana Paula Miyagusko Taba Oguido 2 &
• Antonio Marcelo Barbante Casella 3  

International Journal of Retina and Vitreous volume  10 , Article number:  41 ( 2024 ) Cite this article

27 Accesses

Metrics details

The use of povidone-iodine for ocular surface asepsis is widespread for intravitreal injections. They became frequent procedures, leading to serial exposure of patients’ eyes to iodinated solutions. In this study, we investigate the changes in the ocular surface in patients submitted to repeated use of povidine for intravitreal injection of anti-VEGF asepsis, analyzing Ocular Surface Disease Index, non-invasive break up time, blinking quality, lipid layer, meniscus height and osmolarity.

This case-control study included 34 individuals (68 eyes), 14 males, 20 females aged 48 to 94. Inclusion criteria were individuals who received application of 2% povidone-iodine eyedrops for intravitreal injections treatment with the non-treated contralateral eye used as control. Ocular surface examinations were performed at a single occasion. A pre-intravitreal injection asepsis protocol with povidone-iodine was applied. All statistical analysis was performed using the STATA® 18.0 Software and a p-value = 0.05 was considered as the statistical significance value in all tests.

The median number of IVIs in treated eyes was 12 (range 6–20). The results in treated eyes compared with untreated eyes were respectively : median OSDI 16 (IQR 6–39) and 12.5 (IQR 8–39) ( p  = 0.380); mean NIBUT 10.30 (SD ± 2.62) and 10.78 (SD ± 2.92) ( s, p  = 0.476); median blinking quality 100 (IQR 100) and 100 (IQR 100 ) (%, p  = 0.188); median lipid layer 87 (IQR 77–90) and 86 (IQR 74–100) (nm, p  = 0.451); median meniscus height 0.22 (IQR 0.19-0,31) and 0.24 (IQR 0.20–0.27) (mm, p  = 0.862), median Meibomian gland atrophy 33 (IQR 24–45) and 31.5 (IQR 25–39) (%, p  = 0.524); and mean osmolarity 306.6 (SD ± 21.13) and 313.8 (SD ± 29) (mOsm, p  = 0.297). There was no statistically significant relationship between the repetitive use of 2% iodinated solution and signs or symptoms compatible with dry eye syndrome in this group of patients.

Conclusions

The findings suggest that 2% povidone iodine is a safe and efficacious agent for ocular surface antisepsis during intravitreal injections, not leading to substantial ocular surface modifications. This conclusion supports the continued use of povidone iodine in routine ophthalmic procedures without increased risk of inducing dry eye syndrome.

The use of povidone iodine (PVPI) for ocular surface asepsis is widespread, both for surgical procedures and intravitreal injections [ 1 , 2 , 3 , 4 , 5 ]. Surgeries for cataracts, glaucoma, and intravitreal injections have become common and frequent procedures in ophthalmology, leading to the serial exposure of patients’ eyes to iodine solutions [ 5 , 6 , 7 , 8 , 9 , 10 ]. These changes are directly associated with dry eye syndrome [ 11 , 12 ].

In particular, studies have demonstrated that intravitreal injections used to treat diabetic macular edema or age-related macular degeneration result in significant changes in the ocular surface, leading to dry eye syndrome and damage to homeostasis of the ocular surface [ 5 , 11 , 13 , 14 ].

Dry eye syndrome is a multifactorial disease of the ocular surface characterized by the loss of tear film homeostasis, hyperosmolarity, inflammation, damage and neurosensory abnormalities [ 11 , 15 , 16 , 17 , 18 ]. Its etiology is variable, ranging from nonspecific inflammation of the ocular surface to direct chemical or physical aggression, infections, and autoimmune diseases [ 11 , 12 , 15 , 19 ].

In addition to the most common symptoms, burning sensation, itching, speck, eye redness, excess tearing reflex, brightness sensitivity, and quality of vision loss are also frequent findings that affect efficiency at work and the quality of life of patients [ 11 , 12 , 15 , 19 , 20 ].

This study aimed to observe changes in the ocular surface and tear film due the serial use of 2% PVPI, the gold standard drug for asepsis of the ocular surface. As it is well known that pre-injection antisepsis of the ocular surface with PVPI has a toxic effect on the corneal epithelium, the aim is to identify changes in the tear film and ocular surface and avoid serious problem like dry eye syndrome [ 11 , 12 , 21 , 22 ].

A case-control study was conducted at the Ophthalmology and Psicology Clinic (APMTO MD) in Londrina, Paraná. The patients were recruited from the Retina and Vitreous Institute (AMBC MD) in Londrina, Paraná. The study included 34 individuals (68 eyes). 14 males, 20 females, aged 48 to 94 years. All participants signed the informed consent form, which allowed their participation in the study. Inclusion criteria were individuals who received application of 2% PVPI eyedrops for anti-VEGF IVIs treatment with the contralateral eye used as control, that had not been treated with any topical medication during the same period of applications and good comprehension of the Ocular Questionnaire Surface Disease Index (OSDI). Exclusion criteria were patients who could not understand the OSDI questionnaire; patients using antidepressant medicine, diuretics, sympathomimetics, eye drops for glaucoma, or eye lubricants; people with allergies to iodine; unfavorable clinical conditions to undergo the examination procedures for the study; inappropriate test quantity and quality; unsatisfactory images or unsatisfactory and inadequate data.

The study was approved by the Ethics and Research Committee Involving Human Beings of the State University of Londrina by N. 5.300.176.

The individuals underwent directed clinical and ophthalmological analysis, received explanations about the study, used their data, and signed consent forms. All clinical measures were performed using the IDRA equipment (SBSSISTEMI, Orbasano, Torino, Italy), at which time the OSDI questionnaire was also applied and tear osmolarity was collected using the I-PEN ® (I-MED PHARMA INC. Dollard-des-Ormeaux, QC, Canada). All examinations and administration of the questionnaire were performed by the same professional. No drops or medications that could cause changes in any subsequent measurements were used.

The variables analyzed were age, sex, date of the last PVPI application, number of PVPI applications, OSDI questionnaire, tear osmolarity, NBUT, tear film interferometry, tear meniscus height, percentage of meibomian gland loss, and blink quality. The sequence of procedures obeyed the following order: Explanation to the subject regarding the exams and questionnaire to which he would be submitted, guidance to the patient not to identify in any way the eye being treated and the eye not treated during data collection, nor during the questionnaire OSDI; patient positioning in the IDRA® equipment; capture of blinking quality video images; capture of tear film interferometry; capture of images to measure the height of the tear meniscus and immediate measurement; capture of tear film (NBUT); image capture for the percentage of meibomian gland loss by everting the lower eyelid with a cotton swab; positioning the patient outside the IDRA equipment; application of the I-PEN® electrode to capture tear osmolarity in the lower conjunctiva, first in the right eye, and subsequently in the left eye; application of the OSDI questionnaire.

All statistical analyses were performed using STATA® 18.0 Software and p-values ≤ 0.05 indicated statistical significance.

The Shapiro-Wilk test was used to verify data normality. Data that did not follow a normal distribution were analyzed using the Wilcoxon rank-sum test and were described as means and as medians and interquartile ranges. Data that showed normality were analyzed using the Student’s T test and presented as means and standard deviations. Descriptive, quantitative, and multivariate analyses compared treated (case) and untreated (control) eyes.

The average number of IVIs in treated eyes was 12 (range 6–20). The results in treated eyes compared with untreated eyes were respectively: median OSDI 16 (IQR 6–39) and 12.5 (IQR 8–39) ( p  = 0.380); mean NIBUT 10.30 (SD ± 2,62) and 10.78 (SD ± 2.92) ( s, p  = 0.476); median blinking quality 100 (IQR 100) and 100 (IQR 100 ) (%, p  = 0.188); median lipid layer 87 (IQR 77–90) and 86 (IQR 74–100) (nm, p  = 0.451); median meniscus height 0,22 (IQR 0.19–0.31) and 0.24 (IQR 0.20–0.27) (mm, p  = 0.862), median Meibomian gland athrophy 33 (IQR 24–45) and 31.5 (IQR 25–39) (%, p  = 0.524); and mean osmolarity 306.6 (SD ± 21.13) and 313.8 (SD ± 29) (mOsm, p  = 0.297).). The results revealed that the use of 2% PVPI did not affect the analyzed variables in a statistically significant way. All data is summarized on Table  1 .

These results are disposable on fig 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 and 9 as annexed.

Histogram showing the days of last application of IVIS ( intravitreal injections ) in treated eyes and the density showing the proportion of eyes in each period of time

Histogram showing the number of application ov IVIS ( intravitreal injections ) in treated eyes and the density showing the proportion of eyes in each amount of number of applications

Blue box plot showing score OSDI ( Ocular Surface Disease Index ) in treated eyes comparing with pink box plot showing score OSDI in fellow eyes

Blue box plot showing NIBUT ( non invasive break up time ) in seconds in treated eyes comparing with pink box plot showing NIBUT in seconds in fellow eyes

Blue box plot showing blink quality in treated eyes comparing with pink box plot showing blink quality in fellow eyes

Blue box plot showing lipid layer in treated eyes comparing with pink box plot showing lipid layer in fellow eyes

Blue box plot showing meniscus height in milimeters in treated eyes comparing with pink box plot showing meniscus height in milimeters in fellow eyes

Blue box plot showing Meibomian gland loss in treated eyes comparing with pink box plot showing Meibomian gland loss in fellow eyes

Blue box plot showing tear osmolarity in miliosmoles in treated eyes comparing with pink box plot showing osmolarity in miliosmoles in fellow eyes

Through multivariate analysis, we obtained some interesting outcomes as follows:

When controlling for NIBUT, meibomian gland atrophy, number of applications, and days of the last application according to treatment, sex was an important variable in explaining the variability in the OSDI score (coef = 15.63 | p-value = 0.003). On average, controlling for the abovementioned variables, being female contributed to an increase in the OSDI to 15.63 points.

After controlling for meniscus height and age according to treatment, tear osmolarity contributed significantly to variability in the lipid layer (coef = -0.266, p  = 0.004). In this sense, the addition of one unit in tear osmolarity led to a -0.266 drop in the lipid layer.

After controlling for meniscus height, OSDI, days since the last application, age, and sex according to the treatment, these factors contributed significantly to the variability in the lipid layer [(coef = 0.562 | p-value = 0.004) (coef = − 5.622 | p-value = 0.048)]. In this sense, the addition of one year of age led to a decrease of -0.562 on average. For the same treatment group, female sex led to a decrease of -5,622.

Age, lipid layer, meniscus height, sex according to treatment, age according to treatment, and sex were important factors for explaining the variability in tear osmolarity.

We noticed that a greater age correlated with lower tear osmolarity. However, being in the treated group reduced the decrease in tear osmolarity with advancing age.

Being female implied higher tear osmolarity. However, the increase in tear osmolarity was smaller in the treated group.

A greater height of the lipid layer and meniscus correlated with lower tear osmolarity.

The present study showed that the use of topical PVPI at 2% did not cause significant damage to the ocular surface when the findings of the ocular surface and tear film analyses were used.

Our results contradict some existing data indicating the toxicity of long-term iodine use on the ocular surface; we found two statistically relevant results that the application of iodine may improve the stability of the tear film in the elderly and women, since the eyes in older individuals and female patients that received iodine showed a smaller increase in tear osmolarity [ 4 , 14 , 23 , 24 ].

Moreover, the results of this study corroborated some hypotheses that the use of PVPI could be positive in some dry eye disease diagnostic features, such as the improvement of the tear film meniscus height and the decrease of the tear film osmolarity [ 25 , 26 ].

A localized anti-inflammatory surface effect of the anti-VEGF agent used in intravitreous injections should be considered and assessed in further studies [ 22 , 25 ].

The literature review also shows that there was an improvement in the tear function of some patients who used iodine in ocular asepsis [ 25 , 26 , 27 ], perhaps due to an antimicrobial action preventing the proliferation of bacterial flora that could produce harmful enzymes or cause meibomitis and blepharitis [ 25 , 26 , 28 ].

The cell regeneration mechanism might have satisfactorily recomposed the ocular surface or the tear homeostasis might have compensates for the damage caused by iodine in the cells in question; furthermore, these are just hypotheses.

We also determined that the risk factors for dry eye disease, age and female sex [ 10 , 16 , 29 , 30 ], were associated with the observed clinical data: greater ages lower the height of the tear meniscus, the greater the tear osmolarity, and the smaller the lipid layer of the tear film. The female sex was also associated with higher OSDI scores and fewer tear film lipid layers.

Regardless of the cause or consequence, the osmolarity and lipid layer of the tear film were inversely proportional.

Through multivariate analysis, we determined that the risk factors for dry eye syndrome, age, and female sex correlated with worse results in the tear meniscus measurement tests, OSDI questionnaire, and tear film interferometry, corroborating the literature implicating them as risk factors for dry eye disease [ 20 , 30 , 31 ].

Moreover, due to the sample size, false negatives, or simply because in practice, iodine in the amount and frequency used does not lead to histological damage that may reflect functional changes. The results did not discourage the use of iodine for ocular asepsis but also did not indicate its use for protocols with higher concentrations or more applications than those used in current protocols.

The strengths of the study are as follows: the same patient was the control and treated group, avoiding any environmental or medical bias. The number of injections administered was higher than that reported in other studies. No drops were used during the examination to avoid artificial changes to the tear film.

The limitations of this study were as follows: the study had a small sample size of 34 patients, resulting in 68 eyes being analyzed, which may have caused an analysis bias when using these data in the general population. We must remember that the analyzed population was from southern Brazil and had mostly descended from Italian, German, Spanish, and Portuguese immigrants; therefore, these data may only reflect the specific epidemiology of this population. The meibomian glands analyzed were located in the inferior tarsus.

The use of iodine on the ocular surface was not significantly associated with any of the evaluated parameters. There were no statistically significant correlations between the tests applied to the case eyes. The current study indicates that the application of 2% topical povidone-iodine (PVPI) does not inflict significant damage to the ocular surface, as evidenced by the analyses of the ocular surface and tear film. Notable strengths of this study include the use of the same patient as both the control and the treated subject, which minimizes potential biases from environmental or medical factors. Additionally, the absence of any artificial agents during the examination ensures that the tear film remains unaltered.

Contrary to previous concerns regarding the long-term toxicity of iodine on the ocular surface, our findings suggest potential benefits of iodine application in stabilizing the tear film, particularly in older individuals and female patients. This is supported by a smaller increase in tear osmolarity in these groups following iodine application. Furthermore, the study corroborates hypotheses that PVPI may positively affect certain Dry Eye Disease diagnostic features, such as improved tear film meniscus height and reduced tear film osmolarity.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Povidine or polyvinylpyrrolidone-iodine

• Intravitreal injections

Vascular endothelial growth factor

Ocular Surface Disease Index

Non invasive break up time

Blink quality

Lipid layer

Standard deviation

Interquartile range

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Acknowledgements

APMO provided IDRA analysis, and was a contributor to design the study, revised, written and approved the manuscript. AMBC Applied intravitreal injections and provided patients for the study and was a contributor to design the study, revised, written and approved the manuscript.

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Postgraduate Program in Health Sciences, State University of Londrina, UEL, Londrina, Brazil

José Henrique Casemiro

Department of Health Sciences, Surgical Clinic, State University of Londrina, UEL, Londrina, Brazil

Ana Paula Miyagusko Taba Oguido

Londrina State University, Avenida Robert Koch, 60, Londrina, Paraná, 86038-440, Brazil

Antonio Marcelo Barbante Casella

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JHC analyzed and interpreted patient data, reviewed the literature and was a major contributor to the acquisition of data, interviewed the patients, sponsored supplies, designed the study and written the manuscript. APMO provided IDRA analysis, and was a contributor to design the study, revised, written and approved the manuscript. AMBC Applied intravitreal injections and provided patients for the study and was a contributor to design the study, revised, written and approved the manuscript.

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Correspondence to Antonio Marcelo Barbante Casella .

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Casemiro, J.H., Oguido, A.P.M.T. & Casella, A.M.B. Using 2% PVPI topical solution for serial intravitreous injections and ocular surface findings: a case control study. Int J Retin Vitr 10 , 41 (2024). https://doi.org/10.1186/s40942-024-00557-1

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Received : 11 March 2024

Accepted : 07 May 2024

Published : 29 May 2024

DOI : https://doi.org/10.1186/s40942-024-00557-1

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