Clinical Ophthalmology (Oct 2020)
Signs and Symptoms of Ocular Surface Disease: The Reasons for Patient Dissatisfaction with Glaucoma Treatments
Abstract
Ingeborg Stalmans,1 Hans Lemij,2 Jonathan Clarke,3 Christophe Baudouin4 On behalf of the GOAL study group1Department of Ophthalmology, UZ Leuven, Leuven, Belgium; 2Glaucoma Service, Rotterdam Eye Hospital, Rotterdam, the Netherlands; 3NIHR Biomedical Research Centre - Moorfields Eye Hospital, NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; 4Ophthalmology Unit, Quinze-Vingts National Hospital and Vision Institute, IHU ForeSight, Sorbonne University, Paris, FranceCorrespondence: Christophe BaudouinOphthalmology Unit, Quinze-Vingts National Hospital and Vision Institute, IHU ForeSight, Sorbonne University, Paris, FranceEmail [email protected]: Ocular Surface Disease (OSD) and hyperemia are the most common adverse events of topical ocular medications. While active compounds may cause allergic reactions or irritation, preservatives, which are intended to prevent bacterial growth, are toxic as well. Therefore, the most recent glaucoma medications no longer contain preservatives. Despite this, local tolerability may still impact treatment compliance and patient quality of life. We conducted an observational, multi-center, international, cross-sectional study in 793 treated and stabilized glaucoma patients to assess patient satisfaction and local tolerability of their treatment. The vast majority (93.7%) of patients was satisfied or very satisfied with their treatment in terms of tolerability and only 6.3% were dissatisfied. However, ophthalmological examination showed a high frequency of ocular signs: conjunctival hyperemia (32%), OSD (42.5%) and positive conjunctival fluorescein staining (10.3%). Additionally, patients reported symptoms upon instillation (31.4%) and between instillations (57.3%); 25.1% of patients were using tear substitutes. All signs and symptoms were significantly (p< 0.001) associated with patient dissatisfaction. A logistic regression model indicated that dissatisfaction was higher in patients with symptoms upon instillation and in those using tear substitutes (OR: 3.03 and 4.63, respectively). The mean patient tolerability score to treatment was 82.7± 16.1 on a 100-point visual analogue scale. In conclusion, even if patients may be highly satisfied with their current treatment, most of them present ocular signs and symptoms. A treatment change should be considered in case of clinical signs or patient-reported symptoms.Keywords: glaucoma, tolerance, preservatives, tear substitutes, patient satisfaction, ocular surface disease
