Knowledge and practice of community pharmacists in identifying and managing dry eye disease in Klang Valley of Malaysia. A cross-sectional study
Main Article Content
Keywords
Community pharmacies, CP, Dry eye disease, Knowledge, Practice, Malaysia
Abstract
Background: Inadequately managed dry eye disease (DED) causes complications and poor quality of life. Studies exploring the role of community pharmacists (CP) in identifying and managing DED are scarce. We aimed to determine the level of DED knowledge and practice among CPs and their associated factors in Malaysia’s rapidly developing Klang Valley area. Methods: An online self-administered survey on DED knowledge and practice was conducted from April to June 2023. CPs practising in 10 urban, suburban, and rural districts of Klang Valley were recruited using stratified sampling. Univariate analysis was conducted using the independent T-test, Mann-Whitney U test, analysis of variance, Kruskal-Wallis H test with Dunn-Bonferroni tests, and multivariate analysis by general linear regression. Results: Of the 360 CPs who responded, the majority (87.2%) had an intermediate level of DED knowledge (score 40% to 74%), and 2.5% had a high level of knowledge (score ≥ 75%). Pharmacists with higher academic degrees (P < 0.001) and working in chain pharmacies (P < 0.05) were significantly associated with good DED knowledge. The DED practices of CPs were moderate, with 73.9% scoring 40% to 74%, and 6.9% scoring 75% or above. Younger pharmacists (P < 0.001) with higher academic degrees (P < 0.05) reported comparatively better DED practices. Conclusions: Suboptimal DED knowledge and practices among CPs indicate the need for capacity-building programs to disseminate consistent and updated information on DED management. A collaborative practice platform should also be established to engage CPs in case-based learning and to co-manage DED patients with ophthalmologists.
References
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26. Tsai T, Robin AL, Smith JP. An evaluation of how glaucoma patients use topical medications: a pilot study. Trans Am Ophthalmol Soc. 2007;105:29-33.
27. Stone JL, Robin AL, Novack GD, Covert DW, Cagle GD. An objective evaluation of eyedrop instillation in patients with glaucoma. Arch Ophthalmol. 2009;127(6):732-736.
28. Kass MA, Meltzer DW, Gordon M, Cooper D, Goldberg J. Compliance with topical pilocarpine treatment. Am J Ophthalmol. 1986;101(5):515-523.
29. Okeke CO, Quigley HA, Jampel HD, Ying GS, Plyler RJ, Jiang Y, Friedman DS. Interventions improve poor adherence with once daily glaucoma medications in electronically monitored patients. Ophthalmology. 2009;116(12):2286-2293.
30. Sleath B, Blalock SJ, Covert D, Stone JL, Skinner AC, Muir KW, Robin AL. The relationship between glaucoma medication adherence, eye drop technique, and visual field defect severity. Ophthalmology. 2011;118(12):2398-2402.
31. Robin AL, Covert D. Does adjunctive glaucoma therapy affect adherence to the initial primary therapy? Ophthalmology. 2005;112(5):863-868.
32. Newman-Casey PA, Blachley T, Lee PP, Heisler M, Resnicow K, Klamerus ML, Farris KB. Patterns of glaucoma medication adherence over four years of follow-up. Ophthalmology. 2015;122(10):2010-2021.
33. Friedman DS, Hahn SR, Gelb L, Tan J, Shah SN, Kim EE, Zimmerman TJ, Quigley HA. Doctor–patient communication, health-related beliefs, and adherence in glaucoma: results from the glaucoma adherence and persistency study. Ophthalmology. 2008;115(8):1320-1327.
34. Tsai JC. A comprehensive perspective on patient adherence to topical glaucoma therapy. Ophthalmology. 2009;116(11 Suppl):S30-S36.
35. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497.
36. World Health Organization. Adherence to long-term therapies: evidence for action. World Health Organization; 2003.
37. Hassali MA, Saleem F, Shafie AA, Aljadhey H, Ibrahim MI, Masood I. Assessment of community pharmacists’ perceptions towards professional role expansion in the healthcare system of Malaysia. Int J Pharm Pract. 2014;22(4):232-239.
38. Légaré F, Ratté S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient Educ Couns. 2008;73(3):526-535.
39. Towle A, Godolphin W. Framework for teaching and learning informed shared decision making. BMJ. 1999;319(7212):766-771.
40. Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681-692.
41. Coulter A, Collins A. Making shared decision-making a reality. No decision about me, without me. London: King’s Fund; 2011.
42. D’Amour D, Ferrada-Videla M, San Martin Rodriguez L, Beaulieu MD. The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks. J Interprof Care. 2005;19 Suppl 1:116-131.
43. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2013;(3):CD002213.
44. Thistlethwaite J. Interprofessional education: a review of context, learning and the research agenda. Med Educ. 2012;46(1):58-70.
45. Robben S, Perry M, van Nieuwenhuijzen L, van Achterberg T, Rikkert MO, Schers H, et al. Impact of interprofessional education on collaboration attitudes, skills, and behavior among primary care professionals. J Contin Educ Health Prof. 2012;32(3):196-204. doi: 10.1002/chp.21145. PubMed PMID: 23008082.
46. Spaulding EM, Marvel FA, Jacob E, Rahman A, Hansen BR, Hanyok LA, et al. Interprofessional education and collaboration among healthcare students and professionals: a systematic review and call for action. J Interprof Care. 2021;35(4):612-21. Epub 20191221. doi: 10.1080/13561820.2019.1697214. PubMed PMID: 31865823; PubMed Central PMCID: PMC7305974.
47. Teuwen C, van der Burgt S, Kusurkar R, Schreurs H, Daelmans H, Peerdeman S. How does interprofessional education influence students’ perceptions of collaboration in the clinical setting? A qualitative study. BMC Med Educ. 2022;22(1):325. Epub 20220427. doi: 10.1186/s12909-022-03372-0. PubMed PMID: 35477384; PubMed Central PMCID: PMC9047320.
48. Van Diggele C, Roberts C, Burgess A, Mellis C. Interprofessional education: tips for design and implementation. BMC Med Educ. 2020;20(Suppl 2):455. Epub 20201203. doi: 10.1186/s12909-020-02286-z. PubMed PMID: 33272300; PubMed Central PMCID: PMC7712597.
49. Bridges DR, Davidson RA, Odegard PS, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Med Educ Online. 2011;16(1):6035. Epub 20110408. doi: 10.3402/meo.v16i0.6035. PubMed PMID: 21519399; PubMed Central PMCID: PMC3081249.
2. Ang BCH, Sia TZ, Wong SF, et al. Prevalence of dry eye disease in Malaysia: a systematic review. Int J Environ Res Public Health. 2023;20(5):4213. doi: 10.3390/ijerph20054213.
3. Tong L, Waduthantri S, Wong TY, et al. Impact of symptomatic dry eye on vision-related daily activities: the Singapore Malay Eye Study. Eye (Lond). 2010;24(9):1486-1491. doi: 10.1038/eye.2010.17.
4. Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, Liu Z, Nelson JD, Nichols JJ, Tsubota K, Stapleton F. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276-283. doi: 10.1016/j.jtos.2017.05.008.
5. Gayton JL. Etiology, prevalence, and treatment of dry eye disease. Clin Ophthalmol. 2009;3:405-412.
6. Stapleton F, Alves M, Bunya VY, Jalbert I, Lekhanont K, Malet F, Na KS, Schaumberg D, Uchino M, Vehof J, Viso E, Vitale S, Jones L. TFOS DEWS II epidemiology report. Ocul Surf. 2017;15(3):334-365. doi: 10.1016/j.jtos.2017.05.003.
7. Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31(5):472-478. doi: 10.1097/ICO.0b013e318225415a.
8. Hom MM, Martinson JR, Knapp LL, Paugh JR. Prevalence of dry eyes in young adults. Optom Vis Sci. 1990;67(9):710-714.
9. Schaumberg DA, Sullivan DA, Buring JE, Dana MR. Prevalence of dry eye syndrome among US women. Am J Ophthalmol. 2003;136(2):318-326.
10. Moss SE, Klein R, Klein BE. Prevalence of and risk factors for dry eye syndrome. Arch Ophthalmol. 2000;118(9):1264-1268.
11. Schein OD, Munoz B, Tielsch JM, Bandeen-Roche K, West S. Prevalence of dry eye among the elderly. Am J Ophthalmol. 1997;124(6):723-728.
12. McDonald M, Patel DA, Keith MS, Snedecor SJ. Economic and humanistic burden of dry eye disease in Europe, North America, and Asia: a systematic literature review. Ocul Surf. 2016;14(2):144-167. doi: 10.1016/j.jtos.2015.11.002.
13. Miljanović B, Dana R, Sullivan DA, Schaumberg DA. Impact of dry eye syndrome on vision-related quality of life. Am J Ophthalmol. 2007;143(3):409-415.
14. Nichols KK, Nichols JJ, Mitchell GL. The lack of association between signs and symptoms in patients with dry eye disease. Cornea. 2004;23(8):762-770.
15. Sullivan BD, Crews LA, Messmer EM, Foulks GN, Nichols KK, Baenninger P, Geerling G, Figueiredo FC, Lemp MA. Correlations between commonly used objective signs and symptoms for the diagnosis of dry eye disease: clinical implications. Acta Ophthalmol. 2014;92(2):161-166.
16. McMonnies CW. Key questions in a dry eye history. J Am Optom Assoc. 1986;57(7):512-517.
17. Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000;118(5):615-621.
18. Hassali MA, Saleem F, Shafie AA, Aljadhey H, Ibrahim MI, Masood I. Assessment of community pharmacists’ perceptions towards professional role expansion in the healthcare system of Malaysia. Int J Pharm Pract. 2014;22(4):232-239. doi: 10.1111/ijpp.12047.
19. Zanaridah MN, Norhayati MN, Rosnani Z. Knowledge, attitude and practice of evidence-based medicine among primary care practitioners in Malaysia: a cross-sectional study. BMJ Open. 2021;11(6):e044372. Epub 20210601. doi: 10.1136/bmjopen-2020-044372. PubMed PMID: 34078635; PubMed Central PMCID: PMC8173288.
20. Feng A, O’Neill J, Holt M, Georgiadis C, Wright MM, Montezuma SR. Success of patient training in improving proficiency of eyedrop administration among various ophthalmic patient populations. Clin Ophthalmol. 2016;10:1505-11. Epub 20160810. doi: 10.2147/OPTH.S108979. PubMed PMID: 27570445; PubMed Central PMCID: PMC4986914.
21. Alhamzah NF, Razak SA, Mohd Ali NA. Evaluation of eye drop self-administration technique in a sample of casual eye drop users. Healthscope: The Official Research Book of Faculty of Health Sciences, UiTM. 2022;5(1):37-41.
22. Gao X, Yang Q, Huang W, Chen T, Zuo C, Li X, et al. Evaluation of Eye Drop Instillation Technique and Its Determinants in Glaucoma Patients. J Ophthalmol. 2018;2018:1376020. Epub 20180408. doi: 10.1155/2018/1376020. PubMed PMID: 29850197; PubMed Central PMCID: PMC5911316.
23. Kan YM, Kho BP, Kong L, Chong QX, Tiong MNJ, Wong LMJ. Eye drop instillation technique among patients with glaucoma and evaluation of pharmacists’ roles in improving their technique: an exploratory study. Int J Pharm Pract. 2022;30(6):520-5. doi: 10.1093/ijpp/riac063. PubMed PMID: 35942810.
24. Winfield AJ, Jessiman D, Williams A, Esakowitz L. A study of the causes of non-compliance by patients prescribed eyedrops. Br J Ophthalmol. 1990;74(8):477-480.
25. Hennessy AL, Katz J, Covert D, Kelly CA, Suan EP, Schein OD. A video study of drop instillation in both glaucoma and retina patients with visual impairment. Am J Ophthalmol. 2011;152(6):982-988.
26. Tsai T, Robin AL, Smith JP. An evaluation of how glaucoma patients use topical medications: a pilot study. Trans Am Ophthalmol Soc. 2007;105:29-33.
27. Stone JL, Robin AL, Novack GD, Covert DW, Cagle GD. An objective evaluation of eyedrop instillation in patients with glaucoma. Arch Ophthalmol. 2009;127(6):732-736.
28. Kass MA, Meltzer DW, Gordon M, Cooper D, Goldberg J. Compliance with topical pilocarpine treatment. Am J Ophthalmol. 1986;101(5):515-523.
29. Okeke CO, Quigley HA, Jampel HD, Ying GS, Plyler RJ, Jiang Y, Friedman DS. Interventions improve poor adherence with once daily glaucoma medications in electronically monitored patients. Ophthalmology. 2009;116(12):2286-2293.
30. Sleath B, Blalock SJ, Covert D, Stone JL, Skinner AC, Muir KW, Robin AL. The relationship between glaucoma medication adherence, eye drop technique, and visual field defect severity. Ophthalmology. 2011;118(12):2398-2402.
31. Robin AL, Covert D. Does adjunctive glaucoma therapy affect adherence to the initial primary therapy? Ophthalmology. 2005;112(5):863-868.
32. Newman-Casey PA, Blachley T, Lee PP, Heisler M, Resnicow K, Klamerus ML, Farris KB. Patterns of glaucoma medication adherence over four years of follow-up. Ophthalmology. 2015;122(10):2010-2021.
33. Friedman DS, Hahn SR, Gelb L, Tan J, Shah SN, Kim EE, Zimmerman TJ, Quigley HA. Doctor–patient communication, health-related beliefs, and adherence in glaucoma: results from the glaucoma adherence and persistency study. Ophthalmology. 2008;115(8):1320-1327.
34. Tsai JC. A comprehensive perspective on patient adherence to topical glaucoma therapy. Ophthalmology. 2009;116(11 Suppl):S30-S36.
35. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497.
36. World Health Organization. Adherence to long-term therapies: evidence for action. World Health Organization; 2003.
37. Hassali MA, Saleem F, Shafie AA, Aljadhey H, Ibrahim MI, Masood I. Assessment of community pharmacists’ perceptions towards professional role expansion in the healthcare system of Malaysia. Int J Pharm Pract. 2014;22(4):232-239.
38. Légaré F, Ratté S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient Educ Couns. 2008;73(3):526-535.
39. Towle A, Godolphin W. Framework for teaching and learning informed shared decision making. BMJ. 1999;319(7212):766-771.
40. Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681-692.
41. Coulter A, Collins A. Making shared decision-making a reality. No decision about me, without me. London: King’s Fund; 2011.
42. D’Amour D, Ferrada-Videla M, San Martin Rodriguez L, Beaulieu MD. The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks. J Interprof Care. 2005;19 Suppl 1:116-131.
43. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2013;(3):CD002213.
44. Thistlethwaite J. Interprofessional education: a review of context, learning and the research agenda. Med Educ. 2012;46(1):58-70.
45. Robben S, Perry M, van Nieuwenhuijzen L, van Achterberg T, Rikkert MO, Schers H, et al. Impact of interprofessional education on collaboration attitudes, skills, and behavior among primary care professionals. J Contin Educ Health Prof. 2012;32(3):196-204. doi: 10.1002/chp.21145. PubMed PMID: 23008082.
46. Spaulding EM, Marvel FA, Jacob E, Rahman A, Hansen BR, Hanyok LA, et al. Interprofessional education and collaboration among healthcare students and professionals: a systematic review and call for action. J Interprof Care. 2021;35(4):612-21. Epub 20191221. doi: 10.1080/13561820.2019.1697214. PubMed PMID: 31865823; PubMed Central PMCID: PMC7305974.
47. Teuwen C, van der Burgt S, Kusurkar R, Schreurs H, Daelmans H, Peerdeman S. How does interprofessional education influence students’ perceptions of collaboration in the clinical setting? A qualitative study. BMC Med Educ. 2022;22(1):325. Epub 20220427. doi: 10.1186/s12909-022-03372-0. PubMed PMID: 35477384; PubMed Central PMCID: PMC9047320.
48. Van Diggele C, Roberts C, Burgess A, Mellis C. Interprofessional education: tips for design and implementation. BMC Med Educ. 2020;20(Suppl 2):455. Epub 20201203. doi: 10.1186/s12909-020-02286-z. PubMed PMID: 33272300; PubMed Central PMCID: PMC7712597.
49. Bridges DR, Davidson RA, Odegard PS, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Med Educ Online. 2011;16(1):6035. Epub 20110408. doi: 10.3402/meo.v16i0.6035. PubMed PMID: 21519399; PubMed Central PMCID: PMC3081249.
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Knowledge and practice of community pharmacists in identifying and managing dry eye disease in Klang Valley of Malaysia. A cross-sectional study. Pharm Pract (Granada) [Internet]. 2026 Jan. 9 [cited 2026 Jan. 25];23(4):1-15. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/3317
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How to Cite
1.
Knowledge and practice of community pharmacists in identifying and managing dry eye disease in Klang Valley of Malaysia. A cross-sectional study. Pharm Pract (Granada) [Internet]. 2026 Jan. 9 [cited 2026 Jan. 25];23(4):1-15. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/3317