Contributing Factors Affecting Ocular Discomfort on Instillation and Compliance of 0.1% Cyclosporine A Cationic Nanoemulsion

ABSTRACT

Purpose@#We investigated the contributing factors affecting the ocular discomfort on instillation and compliance of 0.1% cyclosporin A (CsA) cationic nanoemulsion eye drops. @*Methods@#We enrolled patients who were prescribed 0.1% CsA eye drops (Ikervis®) and who filled out an eye drop satisfaction questionnaire to assess ocular discomfort on instillation (questions Q1-Q4) and compliance of eye drops (Q5-Q7). First, to identify the contributing factors affecting the early ocular discomfort of 0.1% CsA instillation and compliance, Q1-Q7 scores were correlated with respect to age, sex, instillation period duration, meibomian gland dysfunction, tear secretion, corneal sensitivity, corneal erosions, Sjögren's International Collaborative Clinical Alliance ocular staining score (OSS), tear matrix metalloproteinase 9 (MMP-9), and ocular surface disease index in patients who completed the first questionnaire within the first 3 months of instillation of 0.1% CsA (referred to as Cohort 1). Second, to evaluate the change in ocular discomfort on instillation and compliance, along with the prolonged instillation of 0.1% CsA, the changes in individual scores for questions Q1-Q7 were analyzed in patients who completed at least two or more serial questionnaires (corresponding to Cohort 2). @*Results@#In Cohort 1 (74 eyes in 39 patients), the scores for ocular discomfort on instillation (Q1-Q4) were higher in females and correlated negatively with the instillation period duration and age and positively with tear secretion, corneal erosions, OSS, and tear MMP-9 grades. The higher the grade of tear MMP-9, the lower the compliance score of Q5. In Cohort 2 (34 patients), the scores for ocular discomfort on instillation tended to decrease as the cumulative instillation period lengthened. @*Conclusions@#The results of this study may aid clinicians in explaining to patients the ocular discomfort on instillation of 0.1% CsA, so as to improve treatment compliance.