Tolerability of Long-acting Diquafosol Ophthalmic Solution as per Tear Film and Meibomian Glands Findings

Long-acting diquafosol (DQS) ophthalmic solution (DQS-LX) has significant advantages regarding patient adherence owing to the reduced frequency of required eye drops; however, some patients prefer conventional DQS over DQS-LX. Herein, to clarify the characteristics of patients according to their preference for ophthalmic solutions, dry eye (DE) and meibomian gland (MG) findings were retrospectively investigated. This study enrolled 341 patients with DE (mean age, 62.1 {+/-} 11.7 years) treated at the Itoh Clinic between November 8, 2022, and July 31, 2023, who switched from DQS to DQS-LX. Patients were divided into two groups: those who continued DQS-LX administration (DQS-LX group) and those who wished to revert to conventional DQS (DQS group). Data regarding subjective symptoms assessed using the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear film breakup time (BUT), tear meniscus height (TMH), corneal and conjunctival fluorescein staining (CFS), conjunctival hyperemia/papilla, meiboscore, plugging, vascularity, meibum grade, and Schirmers score at the time of DQS-LX switch were evaluated. Of the 341 patients, 31 (9.1%) wished to revert to conventional DQS. In total, 32 eyes of 16 patients in the DQS group and 64 eyes of 32 patients in the DQS-LX group--for whom complete data were available--were included in the analysis. Compared with the DQS group, the DQS-LX group had significantly higher SPEED scores, shorter BUTs, lower TMHs, greater CFS findings, larger meibum grades (all P < 0.001), lower Schirmer scores (P = 0.008), and more pluggings (P = 0.001) than the DQS group. More allergic conjunctivitis-related complications were observed in the DQS group (P = 0.034). In conclusion, patients with low tear film volume and DE complicated by moderate or severe MG dysfunction preferred DQS-LX, while those with allergic findings preferred conventional DQS.