Patients accept glaucoma treatment despite ocular surface symptoms
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Most patients reported satisfaction with their glaucoma treatment despite a high frequency of ocular signs during ophthalmological exams and symptoms at and between instillations.
Researchers published the findings in Clinical Ophthalmology.
“To date, patient dissatisfaction with topical glaucoma treatments has only sporadically been studied, and the present study provides new insights in real-life data...,” Ingeborg Stalmans, MD, PhD, department of ophthalmology, Universitair Ziekenhuis Leuven, Belgium, and colleagues wrote.
Stalmans and colleagues conducted an observational, multicenter, international, cross-sectional study of 793 patients (51% men; 91.5% received monotherapy) with treated, stabilized glaucoma (95.1% open angle). The outcomes of interest included patient satisfaction; ocular signs including conjunctival hyperemia, ocular surface disease (OSD) and positive conjunctival fluorescein staining; and patient reports of symptoms on and between instillations.
Most (93.7%) patients reported they were satisfied or very satisfied with the tolerability of their treatment, but patients also commonly reported symptoms at time of instillation (31.4%) and between instillations (57.3%). The most common symptoms reported at instillation were pain or discomfort (21.2%) and blurred vision (7.2%). The most common symptoms reported between instillations were burning (17.4%), crusts on eyelashes (15.9%), red eye (13.1%), photophobia (12.9%), tingling (12.7%), watering (11.9%), itching (9.2%), foreign body sensation (9.0%) and dry eye sensation (5.4%).
“One may hypothesize that a reason for the discrepancy between the high patient satisfaction and the high number of observed tolerance issues may reside, as already highlighted in our previous paper, in the fact that ophthalmologists insist on the importance of controlling IOP, while paying less attention to local intolerability issues,” researchers wrote. “Moreover, ophthalmologists and patients may consider the occurrence of such side effects as ‘the price to pay’ for successfully controlling their glaucoma.”
There was also a high frequency of ocular signs during ophthalmological examination, including conjunctival hyperemia (32%), OSD (42.5%) and positive conjunctival fluorescein staining (10.3%).
Dissatisfaction was higher among patients who reported symptoms at time of instillation (OR = 3.03) and who used tear substitutes (OR = 4.63). Other factors associated with dissatisfaction included hyperemia, OSD and a positive conjunctival fluorescein staining test (P < .001).
“In conclusion, even if patients may be highly satisfied with their current treatment, most of them present [with] ocular signs and symptoms,” researchers wrote. “A treatment change should be considered in case of clinical signs or patient-reported symptoms.”
Perspective
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This observational cross-sectional study of individuals using topical IOP-lowering medication for the treatment of ocular hypertension or glaucoma aimed to determine patient-reported satisfaction with glaucoma medical therapy. In the study, 93.7% of individuals reported to their managing provider that they were satisfied or very satisfied with the tolerability of their current therapy, with mean tolerability score of 82.7 on a 100-point scale. Patients who were dissatisfied with their treatment were more likely to report at least one or more symptom associated with dry eye disease, to have a diagnosis of dry eye disease and to be using tear substitutes.
While most patients may report being satisfied with their current therapy, there is a high prevalence of clinical signs and reported symptoms of local intolerance, even in a cohort of individuals who were nearly all using only one topical IOP-lowering medication.
In clinical practice, many patients require more than one IOP-lowering medication for disease management. With increased exposure to preservatives and active ingredients, which occurs with the use of multiple topical ocular medications, symptoms and clinical signs of dry eye disease are often exacerbated, which may lead to reduced tolerability and satisfaction with therapy. Coexisting dry eye disease in patients medically treated for glaucoma should be anticipated and appropriately addressed and managed. Person-centered management plans for the care of individuals with glaucoma should be developed that include the evaluation of preservative-free medications and procedure-based treatments while considering cost-effectiveness to maximize tolerance and patient satisfaction throughout the course of treatment.
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