Prevalence, severity, and treatment of dry eye disease among patients presenting at community pharmacies in Klang Valley, Malaysia: A cross-sectional study
Pharmacy Practice
Abstract
Background: A healthy tear film ensures ocular comfort, high-quality vision, corneal protection from irritants, and facilitates wound healing. Disruption in the tear film causes dry eye disease (DED), a condition affecting millions globally. Untreated DED produces symptoms such as gritty sensations, ocular discomfort, visual impairment, and reduced quality of life. Pharmacological treatment is necessary if symptoms persist after first-line, non-pharmacological therapies. The Asia Dry Eye Society formulated different dry eye classifications based on abnormal components in the surface epithelium and bilayered tear film, to allow pharmacists to implement tear film-oriented therapy. These include artificial tears, diquafosol sodium, ophthalmic ointments, and rebamipide. Community pharmacists facilitate alternative, convenient and increased access to DED treatments. Although DED is widespread in Malaysia, national data on DED identification and management by community pharmacists is limited. Objectives: To investigate the prevalence, severity, and treatment options for DED among patients presenting at community pharmacies in Klang Valley, Malaysia. Methods: This cross-sectional Ocular Surface Disease Index (OSDI) questionnaire-based study surveyed customers visiting community pharmacies and the retail pharmacists working in these pharmacies in Klang Valley, Malaysia. Results: Of the 217 participants included in this study, DED prevalence was found to increase with age (65 years: 80%; <18 years: 25%, p<0.05). Prevalence was highest in Malay participants (49.23%; p<0.05) and significantly higher in those in urban areas (p=0.002). Furthermore, education was associated with DED prevalence in Klang Valley, Malaysia. The most common symptoms reported by DED patients were sensitivity to light (74.39%) and blurry vision (70.73%). Most participants experienced problems with night driving (87.80%) and reading (79.27%). Additionally, 76.83% of patients felt uncomfortable in air-conditioned and low humidity areas, while 73.17% experienced discomfort under windy conditions. The most recommended management options for DED were Systane hydration UD® eye drops and supplements (e.g., fish oil and Eyegard®). Conclusions: DED prevalence in Klang Valley, Malaysia, was 37.78%, with the disease being either mild (40.34%), moderate (30.49%) or severe (29.27%). Supplements and artificial tears with high viscosity and pH between 6.6 to 7.8 are frequently recommended to these patients by community pharmacists.
Keywords
- Dry eye disease
- Ocular Surface Disease Index
- community pharmacy
- prevalence
- severity
- treatment