Joseph Chiang

Background: Public fluoride varnish (FV) programs, often delivered as part of a multi‐component oral preventive package, rely on the patient's continued participation. However, continued adherence is often poor in real‐world settings. Aim: To synthesize child, family, provider, and systemic level barriers and facilitators influencing adherence and attrition in public FV programs for children < 18 years in multi‐ethnic high‐income countries. Design: Systematic review was conducted in accordance with . Six databases were searched for studies reporting barriers and facilitators to repeated FV applications. Results: From 3616 records, 22 studies were included. Child‐level barriers included behavioral distress, sensory aversion, and temporary medical exclusions. Family‐level barriers included caregiver capacity, health literacy, and mobility. Provider‐level barriers included workforce constraints, training, role boundaries limiting task‐sharing, and weak school/community coordination. System‐level barriers included inequitable reach to high‐risk groups and geographic constraints. Facilitators included culturally safe, relationship‐based engagement, task‐sharing, school/community‐based delivery with active follow‐up systems, and child‐centered engagement strategies. Meta‐analysis demonstrated a pooled attrition rate of 23% (95% CI 8%–43%, n = 14 455). Conclusion: Adherence and attrition in public FV programs are shaped by interacting determinants across child, family, provider, and system levels. Retention should be considered when designing and implementing these programs. Trial Registration: CRD420251044425 (PROSPERO)

The ocular surface is susceptible to a wide spectrum of inflammatory, degenerative, and neurotrophic diseases that can impair vision. The complex pathophysiology and limited therapeutic options associated with these conditions continue to pose significant clinical challenges. Nerve Growth Factor (NGF), a neurotrophin initially recognized for its role in neuronal survival and differentiation, has emerged as a key regulator of ocular surface homeostasis and repair. Beyond its neurotrophic functions, NGF is suggested to influence epithelial proliferation, immune responses, tear secretion, and angiogenesis. Experimental and clinical studies have implicated NGF in both the pathogenesis and potential treatment of various ocular surface diseases, including allergic conjunctivitis, neurotrophic keratopathy (NK), immune-mediated and herpetic keratitis, and dry eye disease (DED), as well as post-surgical corneal wound healing. Notably, recombinant human NGF (rhNGF, cenegermin) has been approved as the first topical biologic therapy for NK. Despite encouraging clinical outcomes, challenges such as high treatment costs, limited long-term data, and potential proangiogenic effects remain. This review consolidates current evidence on the role of NGF in ocular surface health and disease, highlighting its biological mechanisms, clinical applications, and future therapeutic potential.