Stinging, burning sensation after DED medication use a major concern to patients

Patients with dry eye disease (DED) can achieve optimal symptom alleviation with available medications, but getting patients to take their medications remains a challenge due to side effects. Taking the burn or sting out of medications might help, according to a Singapore study.

In a survey that involved 139 patients (mean age 62.7 years, 89.2 percent female, 95.7 percent Chinese), duration of burning/stinging was a major factor when choosing medications. Cost also proved important, whereas duration of blurring was the least important. [Patient 2022;doi:10.1007/s40271-022-00586-8]

“The predicted uptake of a medication increased 18 percentage points when burning/stinging duration decreased from 2 hours 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,” the investigators said.

Taken together, the findings show that burning/stinging sensation was the most important consideration for all patients and point to the potential of mitigating burning/stinging sensation in increasing patient satisfaction and medication adherence, they said. [BMJ Open Ophthalmol 2019;4:e000360; Clin Ophthalmol 2020;14:875-883]

“We also found that patients did not consider vision blurring a major concern. This may be because most (63 percent) reported using medication only once a day. Vision blurring may have also been managed by using eye drops before sleep to limit interference with daily living. This strategy, however, would not help prevent burning/stinging sensation,” the investigators explained.

When it came to cost being a major concern, the investigators were not at all surprised given as, at the time of the survey, the government did not subsidize any prescription DED medications. About 80 percent of the population reportedly paid for their medication out of pocket.

“Regardless of being on or not on medication, symptom control was one of the key factors affecting uptake. These findings are consistent with reports in studies involving patients with eye diseases,” they added.

Specifically, the odds of medication discontinuation due to side effects were found to be low when patients were satisfied with the medication. Likewise, lack of efficacy and poor local tolerance were the primary reasons for medication switching. [Graefes Arch Clin Exp Ophthalmol 2008;246:1485-1490; Clin Ophthalmol 2015;9:785-793]

The investigators pointed to a need for medications or formulate concentrations that reduce burning/stinging sensation. Meanwhile, physicians managing DED patients should discuss the potential side effects of medications and recommend or prescribe remedies to alleviate burning/stinging sensation.

“Future efforts should also target patients who cannot effectively control their symptoms with current medications, as they are more likely to be open to trying new medications. Incorporating patient preferences in treatment decisions could potentially improve patient acceptance of and adherence to a treatment regimen,” they added.

In the study, a Discrete Choice Experiment where patients had to choose between their current medication (or no medication) and two hypothetical medications that varied based on the following 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.