Relationship between the number of glaucoma medications, ocular surface disorder, and treatment adherence

ABSTRACT Purpose: To determine the relationship of ocular surface disease, the number of glaucoma medications prescribed and its influence on treatment adherence. Methods: In this cross-sectional study, demographic data of patients with glaucoma were collected, and patients completed the ocular surface disease index questionnaire and the glaucoma treatment compliance assessment tool. Ocular surface parameters were assessed by “Keratograph 5M.” Patients were stratified into two groups according to the amount of prescribed ocular hypotensive eye drops (Group 1, one or two classes of medications; Group 2, three or four classes) Results: In total, 27 eyes of 27 patients with glaucoma were included: 17 using 1 or 2 topical medications (Group 1) and 10 eyes using 3 or 4 classes (Group 2). For the Keratograph assessment, patients using ≥3 medications had significantly smaller tear meniscus height (0.27 ± 0.10 vs. 0.43 ± 0.22; p=0.037). The analysis of Ocular Surface Disease Index questionnaire showed higher scores among the groups using more hypotensive eye drops (18.67 ± 13.53 vs. 38.82 ± 19.72; p=0.004). Regarding the glaucoma treatment compliance assessment tool, Group 2 had worse scores in components of forgetfulness (p=0.027) and barriers due to lack of drops (p=0.031). Conclusion: Patients with glaucoma using more hypotensive eye drops had worse tear meniscus height and ocular surface disease index scores than those using fewer topical medications. Patients using three or four drug classes had worse predictors of glaucoma adherence. Despite worse ocular surface disease results, no significant difference in self-reported side effects was found.

摘要：
目的：旨在探讨眼表疾病、青光眼处方药物使用种类与治疗依从性之间的关联，以及上述因素对治疗依从性的影响。
方法：本项横断面研究纳入青光眼患者，收集其人口学基线资料，所有患者均完成眼表疾病指数（Ocular Surface Disease Index, OSDI）问卷及青光眼治疗依从性评估工具测评。采用Keratograph 5M对患者眼表参数进行检测。根据处方的眼用降压滴眼液种类将患者分为两组：第1组为使用1~2类药物者，第2组为使用3~4类药物者。
结果：本研究共纳入27例青光眼患者的27只患眼，其中第1组（使用1~2种局部滴眼药物）17只患眼，第2组（使用3~4类药物）10只患眼。Keratograph检测结果显示，使用3类及以上药物的患者泪河高度显著更低（0.27±0.10 vs 0.43±0.22；p=0.037）。眼表疾病指数问卷分析结果表明，使用更多降压滴眼液的组别得分更高（18.67±13.53 vs 38.82±19.72；p=0.004）。针对青光眼治疗依从性评估工具的分析显示，第2组在遗忘用药相关维度（p=0.027）及因药物短缺导致的用药障碍维度（p=0.031）上得分更差。
结论：使用更多降压滴眼液的青光眼患者，其泪河高度及眼表疾病指数得分均差于使用较少局部滴眼药物的患者。使用3~4类药物的患者，青光眼治疗依从性的预测指标更差。尽管眼表疾病相关检测结果更差，但患者自我报告的不良反应并无显著差异。