Parents' views on their children's use of eye drops and willingness to accept a new sustained-release subconjunctival injection

Subpalpebral lavage placement for remote topical administration of ocular medications in 12 dogs: A retrospective review and assessment of owner perception

OBJECTIVE

The aim of this study was to describe the placement of subpalpebral lavage (SPL) systems in 12 dogs (15 eyes) intolerant of topical ocular medications to assess the suitability, complications encountered and owner perception of use.

ANIMALS STUDIED

Retrospective review of dogs that underwent SPL placement for treatment of ocular disease at the Ophthalmology Department, University of Bristol Small Animal Hospital between 2017 and 2021.

PROCEDURE(S)

Data recorded included signalment, history, diagnosis, treatment, reason for SPL placement, uni- or bilateral placement, duration of placement, complications, and outcome. Owner perception was assessed using an online questionnaire. Statistical analysis included McNemar and Wilcoxon signed-ranks tests.

RESULTS

Twelve dogs (15 eyes) underwent SPL placement. Eleven owners completed the online questionnaire. Corneal ulceration was the most common disease requiring SPL placement (n = 13/15 eyes, 86.7%). Most cases received multimodal topical therapy (n = 9/15 eyes, 60.0%) via SPL. Owners administered medication 6.63 times daily via SPL (range 1-16 applications/day). All dogs requiring ongoing topical medication (n = 8/12, 66.7%) were trained to accept direct administration during SPL treatment. Statistically significant improvements in medication compliance, ease of application, and reduced perceived risk of iatrogenic ocular injury were reported by owners (p-value = .001, .004, and .031 respectively). Minor complications were infrequently reported but an excellent outcome was achieved for all eyes.

CONCLUSION

Subpalpebral lavage placement provides a practical and safe solution for the provision of frequent multimodal ocular medication when treating patients with a challenging temperament.

Patient Preferences for Medications in Managing Type 2 Diabetes Mellitus: A Discrete Choice Experiment

OBJECTIVES

To quantify patients' maximum acceptable risk (MAR) of urinary and genital tract infections (UGTI) in exchange for benefits associated with treatments for managing type 2 diabetes mellitus (T2DM).

METHODS

In a discrete choice experiment, adult patients with T2DM and currently on metformin and/or sulphonylurea (first-line treatments) were asked to choose between 2 hypothetical medications defined by 6 attributes: years of medication effectiveness in controlling blood glucose, weight reduction, UGTI risk, risk of hospitalization from heart failure, all-cause mortality risk, and out-of-pocket medication cost. We used latent class logistic regression parameters to estimate the conditional relative importance of treatment attributes and MAR of UGTI for various treatment benefits.

RESULTS

A 2-class latent class model was identified as the best fit for the responses from 147 patients. The first class (49% of sample), termed as "survival-conscious," stated that they were willing to accept 46% (95% confidence interval [CI]: 2%-90%) UGTI risk in exchange for a reduction from 6% to 1% in all-cause mortality risk. The second class (51% of sample), termed as "UGTI/cost-conscious" were willing to accept significantly lower (6%; CI: 2%-11%, and 5%; CI: 2%-8%) UGTI risk in exchange for the same reduction in all-cause mortality and hospitalization risks, respectively.

CONCLUSIONS

On average, patients were willing to trade higher UGTI risk for a more effective medication. Our findings suggest that physicians should present the benefits and potential side effects of all available treatments and consider patient preferences in their treatment recommendations.