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 Schirmer’s 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.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was approved by the Institutional Review Boards of Itoh Clinic, and it adhered to the tenets of the Declaration of Helsinki. (Registry ID: IRIN2023-0909). Informed consent was obtained from all the participants. This study was registered with the University Hospital Medical Information Network (Registration ID: UMIN000054378).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All relevant data are within the manuscript and its tables.