Comparing the needs and preferences of patients with moderate and severe dry eye symptoms across four countries

Perspectives of dry eye patients in the United Kingdom on risk factors and desired treatment outcomes

PURPOSE

Successful management of dry eye disease depends upon an effective two-way communication between eyecare practitioners and affected patients. However, there has been limited investigation into the perspectives of patients with dry eye disease in the United Kingdom regarding their risk factors and desired treatment outcomes.

METHODS

An online, self-administered, anonymous survey was distributed to patients based in the United Kingdom who have had a diagnosis of dry eye disease between November 2023 to March 2024. The survey consisted of four main sections including demographics, the 5-item Dry Eye Questionnaire (DEQ-5), and Likert scales rating the likelihood of various risk factors contributing to their dry eyes and the desired treatment outcomes in various components of signs and symptoms.

RESULTS

The survey was completed by 152 respondents (mean age 51.7 ± 16.7 years, 103 females). Respondents rated environmental conditions the highest in terms of likelihood of contributing to their dry eye disease [median (interquartile range): 7.5 (5-10)], followed by digital device use [7 (4-9)] and poor sleep quality [4 (1-7)]. In terms of desired treatment outcomes, symptom frequency and severity as well as tear stability were ranked the highest in importance [10 (8-10)].

CONCLUSIONS

This survey demonstrated the perceptions of dry eye patients in the United Kingdom regarding lifestyle or modifiable risk factors contributing to their dry eye disease, as well as the most important treatment outcomes of these patients. These aspects should be considered by clinicians in the management of dry eye disease, as well as researchers particularly when designing studies which investigate treatment effects of current and novel dry eye interventions.

Utilising Narrative Medicine to Identify Key Factors Affecting Quality of Life in Dry Eye Disease: An Italian Multicentre Study

INTRODUCTION

Despite an improved understanding of its pathogenesis, dry eye disease (DED) remains relatively underestimated and its treatment challenging. A better alignment between the clinical evaluation and the patient self-assessment also requires capturing the whole patient experience of DED. This project aimed to unveil this experience through narrative medicine (NM).

METHODS

The project involved 38 expert centres in Italy and one in San Marino, targeting adult patients with DED, their informal caregivers and their treating ophthalmologists. Written narratives and sociodemographic and quality of life (QoL)-related data were anonymously collected through the project's webpage. Narratives were analysed through MAXQDA (VERBI Software, Berlin, Germany), NM classifications and content analysis.

RESULTS

A total of 171 patients with DED, 37 informal caregivers and 81 ophthalmologists participated in the research. DED was defined as a disabling condition by 19% of patients and 35% of caregivers; 70% of patients reported that a therapeutic alliance is an integral part of DED treatment and 32% hope for more effective therapies. Forty-four per cent of patients assessed their own QoL as good; however, DED emerged as importantly impacting work performance and social events. DED physical, emotional and economic burden and the cruciality of a trusting care relationship represent the main themes that emerged across all narratives, while empathy and effective treatment are among the factors favouring coping with DED.

CONCLUSION

This project marked a pioneering initiative investigating the lived experience of patients with DED through NM, simultaneously involving all viewpoints involved in the care pathway. NM enabled the unveiling of factors favouring the ability to cope with DED and its associated QoL implications and provided valuable insights to improve the therapeutic alliance.

Dry eye symptoms and health-related quality of life among Chinese individuals: a national-based study

AIMS

To assess the impact of dry eye symptoms (DESs) on health-related quality of life (HRQOL) among Chinese residents.

METHODS

A total of 21 916 participants were involved in this nationwide cross-sectional study. All of them completed the Ocular Surface Disease Index-6 and the five-level European Quality of Life 5-Dimensional (EQ-5D) Questionnaire to assess the severity of DES and HRQOL, respectively. Multiple linear regression models were used to explore the associations of DES with EQ-5D health utility score (HUS) and visual analogue scale (VAS) score. We used logistic regression models to assess the relationships between DES and self-reported problems in the EQ-5D dimensions.

RESULTS

Overall, 43.6% of participants reported DESs. Of them, 2511 (11.5%) were with mild symptoms, 2762 (12.6%) were with moderate symptoms and 4288 (19.6%) were with severe symptoms. Both EQ-5D HUS and VAS score were significantly negatively associated with the severity of DES. The difference in HUS between patients with no symptoms and severe symptoms (0.085) was larger than the minimally clinical important difference for EQ-5D. The loss in HRQOL was greater for patients with severe DES than those just with other comorbidities. Participants with DES had a significantly higher risk of reporting problems in all five EQ-5D dimensions, especially in pain/discomfort and anxiety/depression for patients with mild or moderate symptoms and in mobility, self-care and usual activities for severe patients.

CONCLUSION

Patients with more severe DES tend to have lower HRQOL. Effective interventions targeted at different HRQOL dimensions should be taken according to the severity of DES.

Optometrists need to incorporate their understanding of the impact of dry eye disease in their patient management

SIGNIFICANCE

The impact of dry eye disease on patients' daily lives is understood by optometrists, but they seldom use this understanding in their patient management.

PURPOSE

Dry eye disease can significantly impact a person's daily life and is known to cause psychological symptoms. Treating and managing patients with dry eye disease can be challenging, as an approach based solely on signs is unlikely to reflect patients' true burden. Because optometrists play a crucial role in the care of dry eye disease patients, it is necessary to examine their awareness of the negative impact of dry eye disease on patients' daily lives and how they manage this during their consultation time, including diagnosis and management.

METHODS

This study has an exploratory, qualitative research design. Twelve semistructured online interviews were conducted with optometrists in second-line eye care through a convenience sample. The interviews were recorded, transcribed verbatim, and analyzed after a thematic analysis.

RESULTS

The main findings were that few optometrists actively asked about patients' perceived burden, many optometrists did not mention all the possible treatment options or practical advice that could benefit dry eye disease patients, and few were aware of the possible help that other health care providers could provide, besides the optometrist.

CONCLUSIONS

Dutch optometrists are aware of the impact that dry eye disease can have on their patients' daily lives, but seldom use this information as part of their management plan.

The Efficacy and Safety of Rebamipide Ophthalmic Suspension (OPC-12759) in Patients with Dry Eye Disease: A Systematic Review of Randomized Controlled Trials

The aim of this paper is to evaluate the efficacy and safety of Rebamipide (REB) ophthalmic suspension in dry eye disease (DED). A systematic review that only included full-length randomized controlled studies (RCTs) reporting the effects of REB ophthalmic suspension in three databases, PubMed, Scopus and Web of Science, was performed according to the PRISMA statement. The Cochrane risk of bias tool was used to analyze the quality of the studies selected. A total of seven studies were included in this systematic review. Although the overall risk of bias was low, most studies were sponsored by the manufacturer. REB ophthalmic suspension treatment achieved higher improvement than the control group in all reported variables. The mean differences between both groups were in favor of the REB group and were as follows: dry eye-related quality of life score (DEQS) -3.5 ± 2.9 points, tear film break-up time (TBUT) of 0.7 ± 0.6 s, Schirmer test (ST) without anesthesia of 0.3 ± 0.6 mm and total corneal fluorescein staining (tCFS) of -1.2 ± 0.7 points. Adverse events (AEs) were 5.2 ± 7.6% superior in the REB group, with an overall compliance > 95%. Therefore, REB ophthalmic suspension is a safe and effective treatment that could be recommended in patients with DED.

Patient Medication Preferences for Managing Dry Eye Disease: The Importance of Medication Side Effects

OBJECTIVES

The side effects of dry eye medications can lead to medication non-adherence and, eventually, to poor outcomes. This study aimed to quantify to what extent the side effects of dry eye disease (DED) medications (burning/stinging sensation and blurring) are important to patients compared to medication benefits or costs.

METHODS

Patients diagnosed with DED were recruited at a referral eye center in Singapore (n = 139). This study utilized a Discrete Choice Experiment where patients were presented with 10 choice tasks where they were asked to choose between their current medication (or no medication), and two hypothetical medications that varied based on five attributes: duration of burning/stinging, duration of blurring, time to medication effectiveness, medication frequency, and out-of-pocket cost. The main outcomes were relative attribute importance and predicted uptake.

RESULTS

Latent class logistic regressions found two groups with distinct preferences. For both classes, duration of burning/stinging (Class 1 = 23%, Class 2 = 29%) and cost (Class 1 = 24%, Class 2 = 27%) were the most important attributes while duration of blurring (Class 1 = 15%, Class 2 = 9%) was the least important. The predicted uptake of a medication increased 18 percentage-points when burning/stinging duration decreased from 2 h to a few minutes. The predicted uptake for new medications was lowest for those on medication with well-controlled symptoms and highest for those who were not on medication and could not control their symptoms effectively.

CONCLUSION

This study showed that duration of burning/stinging was an important factor when choosing medications. Incorporating patient preferences in medication decisions can potentially improve patient acceptance of a treatment regimen.

Patient perspectives on dry eye disease and chronic ocular surface pain: Insights from a virtual community-moderated dialogue

PURPOSE

To understand patients' perspectives on living with dry eye disease (DED), and on the unmet needs in DED and chronic ocular surface pain (COSP) management.

METHODS

A moderated, structured discussion with patients with ocular surface diseases and healthcare professionals (HCPs) was conducted using a virtual platform to capture patients' journey with DED, their opinion on unmet needs, and design and conduct of clinical trials in DED and COSP.

RESULTS

Nine participants, including four patient representatives from patient organisations, one ophthalmologist and one optometrist participated in the discussion. Patients had DED of varying severity and aetiology; three patients had Sjögren's. Over 4 weeks, 785 posts were entered on the platform. Prior to diagnosis, patients rarely associated their symptoms with DED. Convenience and symptomatic relief scored higher than treating the disease. Patients expressed the need for plain language information and dialogue with knowledgeable and sensitive HCPs. Online forums and social media were suggested as key recruitment resources, whereas convenience and safety concerns were highlighted as main barriers to enrolment. The need for the inclusion of outcome measures that have a real impact on patients' experience of their condition was highlighted. Both target product profiles were received positively by participants, highlighting the twice-daily dosing regimen and convenience of the products. Participants acknowledged the value of digital tools and suggested the need to feel valued post-trial.

CONCLUSIONS

This moderated dialogue provided actionable insights on the unmet needs in DED and useful inputs for consideration when designing future clinical trials for DED and COSP.

Living with presbyopia: experiences from a virtual roundtable dialogue among impacted individuals and healthcare professionals

BACKGROUND

Presbyopia is a common progressive vision disorder characterised by an inability to focus on near objects. The emergence of newer treatment options in addition to spectacles or contact lenses highlights the importance of assessing patient/user preferences.

METHODS

People with presbyopia and healthcare professionals (HCPs) took part in a moderated, structured discussion of specific questions on a virtual advisory-board platform. The objective was to better understand unmet needs and the experience of living with the condition. Closed and open questions were included.

RESULTS

Nine individuals (age 40 to 70 years) with presbyopia participated, from Australia, China, France, Italy, Ireland, Japan and the US. One ophthalmologist and one optometrist represented the perspective of HCPs. Over two weeks, 621 posts were entered on the platform. There was widespread agreement that the often stated association between age and presbyopia was unfortunate. Some participants had developed presbyopia at 30-45 years of age. What is more, the association with age was seen as implying a natural process, reducing the incentive to treat. Instead there was a call for an action-oriented view of presbyopia as a condition which may be effectively treated in the future. All participants experienced dealing with presbyopia as burdensome, affecting quality of life to varying degrees. When considering new treatments, convenience was the most important factor. The option to administer drops when needed was considered favourable, but short-acting treatments may not reduce inconvenience compared with spectacles. Participants viewed a therapy that targets the underlying cause of the condition favourably compared with symptomatic treatment. Side effects would severely reduce the appeal of drops. For clinical trials in presbyopia, patient-reported outcomes should be mandatory and need adequately to capture quality of life. Studies in presbyopia must be designed to minimise the inconvenience to participants in order to counter the risk of high drop-out rates.

CONCLUSIONS

The interactive format provided insights into living with presbyopia, particularly the negative impact on quality of life, subjects' openness to new therapies, and the need to move away from considering the condition an unavoidable and intractable consequence of ageing.

A phase II randomized trial to evaluate the long-term (12-week) efficacy and safety of OC-01 (varenicline solution) nasal spray for dry eye disease: The MYSTIC study

PURPOSE

Dry eye disease is characterized by loss of tear film stability. OC-01 (varenicline solution) is a small-molecule nicotinic acetylcholine receptor agonist administered as a nasal spray that stimulates tear production.

METHODS

In MYSTIC (NCT03873246) patients aged ≥22 years with dry eye disease were randomized 1:1:1 to OC-01 0.03 mg, OC-01 0.06 mg, or vehicle (n = 41 per group), administered twice daily via intranasal spray, for 12 weeks (84 days). Primary efficacy endpoint was mean change from baseline in anesthetized Schirmer's test score (STS) in study eye at day (D) 84.

RESULTS

Patients receiving OC-01 0.03 and 0.06 mg had statistically significantly increased tear production at D84 versus vehicle; least squares mean changes from baseline in STS were 10.8 mm and 11.0 mm for OC-01 0.03 and 0.06 mg, respectively. A trend toward a higher proportion of patients experiencing ≥10-mm improvement in STS from baseline was observed with OC-01 0.03 mg (36.6%; p > 0.05), and was significant for OC-01 0.06 mg (48.8%; p = 0.024), versus vehicle (24.4%). Non-ocular treatment-emergent adverse events (TEAEs) were reported by 21 patients; the most common was sneezing (OC-01 0.03 mg, 2 [4.9%]; OC-01 0.06 mg, 3 [7.3%]), with similar frequencies between treatment groups. No severe or serious TEAEs were reported.

CONCLUSIONS

OC-01 (varenicline solution) nasal spray improved tear production in patients with dry eye disease over a long-term (12-week) period, and represents a receptor neuro-activator with a nasal route of administration that spares the ocular surface to stimulate tear production.

Patient-reported experience of dry eye management: An international multicentre survey

PURPOSE

To explore the journey taken by patients in a range of different countries to manage their dry eye symptoms.

METHOD

Members of the general public who responded positively to the question "Do your eyes ever feel dry?" completed a questionnaire describing their demographics, the impact of their symptomology, the advice they have received and the management options they have tried. The Ocular Surface Disease Index (OSDI) questionnaire was also completed.

RESULTS

A total of 916 individuals (Canada = 235, Mexico = 127, New Zealand = 157, Taiwan = 246, UK = 151) of similar age distribution (median 38 years, IQR: 27-50) completed the survey. The reported duration of symptoms was longest in Canada (median 4 years, range 2-10) and least in Taiwan (2 years, range 1-3; p < 0.001), and similar trends were observed for symptom severity (p = 0.001). However, there was no statistically significant difference between countries with respect to the impact of symptoms on quality of life (median 3/10; p = 0.08). Less than half of the individuals in any country had consulted with a health professional. About half had tried a treatment for their dry eye symptoms, with artificial tears being the most common treatment, followed by warm compresses, and both therapies were rated as reasonably effective (median 5-7/10).

CONCLUSION

Many people with dry eye symptoms are not consulting health care professionals who can confirm the diagnosis, exclude differential diagnoses, and offer a wide range of treatments targeted at the dry eye subtype.

Defining the needs and preferences of patients with dry eye disease

OBJECTIVE

Dry eye disease is a multifactorial chronic disease, leading to ocular discomfort and visual disturbance with a substantial impact on quality of life. Therefore, the patient's perspective should be taken into account early in the drug development process. We have developed a step-by-step methodology based on the self-explicated conjoint approach to assess the needs and preferences of patients with moderate-to-severe dry eye disease.

METHODS AND ANALYSIS

Following a literature review and social media listening (step 0), qualitative phone call interviews were conducted with 12 patients (step 1). Patients' responses underwent content analysis and were coded, quantified and displayed as charts. Based on the emerging trends and attributes identified as relevant in steps 0 and 1, a quantitative online questionnaire was designed and conducted with 160 patients across four countries (step 2).

RESULTS

The online questionnaire was rated as easy/very easy to understand by 60% of respondents, 62% rated the survey as easy/very easy to complete and 71% rated it as interesting/very interesting. Treatment satisfaction was the most important aspect for patients, and the three most relevant attributes were as follows (with the most important indexed to 100%): 'treatment effectiveness on symptoms of dry eyes' (100%), 'frequency of treatment use' (96%) and 'how the treatment works' (95%).

CONCLUSION

Our methodology was well received by patients, and the results will help inform future clinical trial development and discussions with health technology assessment bodies and regulators on unmet needs and product attributes that are of most value to patients with dry eye disease.