Abstract :
[en] Introduction A few medications can cause ocular toxicity. Indeed, the eye is a complex organ, and even minor damage can have significant functional consequences.1 While the entire eye may be susceptible to toxicity, it is not uncommon for specific structures, such as the retina or cornea, to be affected.2 Some medications can cause visual impairment3 and other present an increased risk in case of visual impairment. Additionally, some dosage forms are challenging for these patients to utilise. It is therefore essential to identify high-risk medications for visually impaired patients and to provide guidance on minimising risks.
Purpose To create and validate a tool to assist in prescribing and dispensing high-risk medications linked to molecules and dosage forms to visually impaired patients.
Materials and methods An analysis of the Summary of Product Characteristics (SPC) of the medications listed in the Répertoire Commenté des Médicaments/Gecommentarieerd Geneesmiddelen Repertorium (RCM/GGR) and a literature search were performed to identify high-risk medications and complex dosage forms for visually impaired patients. After organising and synthesising the data, a prescribing and dispensing tool was created. A Delphi survey for consensus building was then conducted by a French-speaking European panel of experts. The experts were invited to indicate their degree of agreement on a four-point Likert-scale and descriptive statistics were produced using IBM SPSS software. This process was repeated until a consensus was reached between all experts.
Results The RCM/GGR comprises 1,875 medications. On the 1,050 medications analysed, 759 were initially included in the tool, i.e. 40.5% of the medications. Furthermore, six articles highlighted challenges associated with the administration of eye drops and insulins. The tool was divided into two sections: Table 1, which contains high-risk medications, and Table 2, which contains dosage forms. The dosage forms were classified according to the site of administration, with seven sites included in the tool. Four rounds of the Delphi method were necessary to the panel of nine experts to evaluate the tool. Ultimately, 851 compounds were included in the tool, i.e. 45.4% of the medications in the RCM/GGR.
Discussion This tool was developed for community pharmacists and physicians to help them provide quality outpatient care to their visually impaired patients. The Delphi method is designed to identify consensual proposals around a given concept.4 In the course of this study, an evaluation was conducted to ascertain which elements required removal or addition. The experts concentrated on the significance of incorporating vaccines and minor ocular effects, as well as the necessity of eliminating secondary risks to reduce the complexity of the tool.
Conclusion The consensus process ensured a consolidated and relevant tool for disseminating high-quality content to Belgian community pharmacists and physicians.
