Researcher: Realistic patient expectations critical to managing dry eye
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Patients with dry eye disease should be educated about managing their disease to make treatment more successful, according to a review of dry eye disease treatment published in Clinical Ophthalmology.
“Many clinicians may find it challenging how time-consuming it is to educate patients on both the need of multiple treatments and lifestyle modifications,” Bridgitte Shen Lee, OD, FAAO, FBCLA, of Vision Optique, Houston, told Primary Care Optometry News. “Managing dry eye disease (DED) and patient expectations appropriately are necessary to ensure patient satisfaction and compliance with dry eye treatment.”
There is no cure for DED, and ongoing management and treatment is required, Shen Lee and colleague said in their review.
In a study by Schaumberg and colleagues, women reported higher frequency, severity and impact of symptoms compared to men in the Women’s Health Study and the Physicians’ Health Studies I and II. The study also showed that women were more likely to use artificial tears, topical cyclosporine and supplements and undergo punctual occlusion. In a follow-up study by Lienert and colleagues, improvements in patient-reported changes and worsening since diagnosis were evaluated for ocular surface symptoms (44% vs. 24%), vision-related symptoms (19% vs. 29%) and social impact (19% vs. 10%).
Ocular lubricants are one of the more common forms of DED therapy. Pan and colleagues and Pucker and colleagues reported that in a Cochrane review of artificial tears in 43 randomized control trials, 3,497 participants found most formulations produce similar symptom relief.
Sall and colleagues showed in another study that topical cyclosporine 0.05% significantly improved DED signs after 21 weeks of use in most trials with less consistent findings for symptom improvement.
Prescription medications may include limited-duration topical corticosteroids, topical cyclosporine and the lymphocyte function-associated antigen (LFA)-1 antagonist, lifitegrast. In a year-long safety study of lifitegrast by Donnenfeld and colleagues, 15% of patients receiving lifitegrast had an adverse instillation site irritation event, 13.2% experienced instillation site reaction, 11.4% reported decreased visual acuity and 16.4% complained of dysgeusia.
Goldberg and colleagues, in a phase 2b/3 and a phase 3 randomized control trial evaluating OTX-101, a novel, aqueous, nanomicellar ophthalmic solution of cyclosporine in a preservative-free aqueous solution, found that OTX-101 increased tear production (P = 0.0003) at 12 weeks. Overall, 15% of patients who received OTX-101 0.09% vs. 3% who received vehicle experienced instillation site pain in the phase 2b/3 study, and 24% vs. 4% in the phase 3 study.
According to a study by Jones and colleagues, the Tear Film & Ocular Surface Society Dry Eye Workshop (TFOS-DEWS) II recommends individualized management of DED based on the pathophysiology and disease severity. For patients with early-stage DED, conventional, low-risk and commonly available therapies such as warm compresses and over-the-counter artificial tears or other lubricants can be used as first-line treatment. All management strategies for DED require careful follow-up, and detailing instructions for patients is important to determine whether patients are being consistent in implementing their treatment and to assess improvement symptoms or signs.
Patient education is vital in managing and treating DED, Shen Lee and colleagues said in their review. Patients should understand the need for continual treatment and be aware that results may not show immediately. Managing DED may require more than one therapeutic modality, and the mechanism of action, goals of treatment and expected treatment length should be adequately explained in lay terms.
“Setting realistic patient expectations is essential when managing patient with dry eye disease,” Shen Lee told PCON. “Interventions for dry eye treatment may be slow to yield results, and educating patients helps ensure that they remain compliant with the overall plan.”
Deveney and colleagues conducted a study that showed high rates of patient satisfaction and intention to continue their DED treatment, but health claims data revealed that patients fill their dry eye medication for an average of only 4.4 months over a 1-year period.
In a separate study from Trattler and colleagues, self-reported adherence with prescribed topical cyclosporine 0.05% twice per day was associated with onset of increase in tear production as well as greater patient satisfaction and continuation of therapy.
Newer options for DED treatment therapy, such as OTX-101, may help decrease duration of time to symptom relief, which may provide incentive for patients to continue their treatment, Shen Lee and colleagues said. The appropriate management of DED and facilitating more realistic expectations for patients is necessary in ensuring patient satisfaction and compliance with their treatment.
“The newer treatments for dry eye disease, such as Cequa [OTX-101; cyclosporine ophthalmic solution 0.09%, Sun Pharmaceutical], show a faster onset of effect for a cyclosporine product,” Shen Lee added. “The newer treatment options may also have a favorable tolerability profile, which can improve patient compliance with pharmacological treatment.” – by Erin T. Welsh
References:
Deveney T, et al. Clin Ophthalmol. 2018;doi:10.2147/OPTH.S115098.
Donnenfeld ED, et al. Cornea. 2016;doi:10.1097/ICO.0000000000000803.
Goldberg DF, et al. Ophthalmology. 2019;doi:10.1016/j.ophtha.2019.03.050.
Jones L, et al. Ocul Surf. 2017;doi:10.1016/j.jtos.2017.05.006.
Lienert JP, et al. Ophthalmology. 2016;doi:10.1016/j.ophtha.2015.10.011.
Malhotra R, et al. Cornea. 2019;doi:10.1097/ICO.0000000000001989.
Pan Q, et al. Cochrane Database Syst Rev. 2017;doi:10.1002/14651858.CD009327.pub3.
Pucker AD, et al. Cochrane Database Syst Rev. 2016;doi:10.1002/14651858.CD009729.pub2.
Sall K, et al. Ophthalmology. 2000;doi:10.1016/S0161-6420(99)00176-1.
Schaumberg DA, et al. PLoS One. 2013;doi:10.1371/journal.pone.0076121.
Tauber J, et al. Clin Ophthalmol. 2018;doi:10.2147/OPTH.S175065.
Trattler W, et al. Clin Ther. 2006;doi:10.1016/j.clinthera.2006.11.016.
For more information:
Bridgitte Shen Lee, OD, FAAO, FBCLA, can be reached at Vision Optique, Houston; Twitter handles: @VisionOptique @DrBridgitte.
Disclosure: Shen Lee reports receiving consultant fees from Guardian Health Sciences and personal fees from EyeVance and Shire; consultant and personal fees from Alcon, Johnson & Johnson Vision, Lumenis, OcuSoft, Sun Pharmaceutical. Please see the full study for all other authors’ financial disclosures.
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