Several studies conducted in many populations around the globe have demonstrated that self-medication is a common practice, even in populations with very different characteristics . Is known that the use of non-prescribed drugs by an individual, results from a genuine or apparent need to mitigate or attenuate discomfort, with this behavior having been related to various sociodemographic, sociocultural and socioeconomic factors, including age, sex and education, among others [11
Our study reveals comparable rates of ocular self-medication in the Argentinean and Colombian groups confirming that this practice is equally common in both countries taking into account ophthalmic patients. One out of every four patients used eye drops without prescription in both studied populations. This practice, however, is not exclusive to these two Latin American countries, as shown by the study of Santos et al which described approximately the same percentage of self-medication in a larger population of elders from Goiana, Brazil [16
]. Nevertheless, these rates are fairly low when compared to frequencies published by Carvalho et al. [10
], who reported a prevalence of eye self-medication as high as 40.5%. This discrepancy may be explained on the basis of the study design, with the main difference being that the paper by Carvalho et al. only sought to identify the practice of self-medication in the treatment of ocular emergencies, whereas in our study the questionnaire was carried out on patients presenting and requesting ophthalmic attention at two private tertiary care ophthalmology clinics, and who were not necessarily on emergency visits. We also observed another difference between these two investigations, which was that ours only contemplated patients who had self-medicated during the previous year and who had only taken into consideration the use of commercial eye drops, rather than the homemade topical medications considered in Carvalho’s study [10
]. These substances were likely to be used by the people in our sample, but we decided not to count them at stated in the methods section. These kind of medicines are preparations usually made ??by the patient with products often easily found at home, like lemon juice, milk of lactating woman, salt water and different types of teas and beverages, among others. Including them could increased the percentage of people who self-medicated in our populations to be more comparable to the 40% of Carvallo.
Ophthalmic self-medication seemed to be independent of gender in the Colombian population, as well as in the Brazilian cohort [10
]. However in the Argentinean population a higher tendency to use this approach was found in men. Regarding age, all these three Latin American studies demonstrated that the misuse of ophthalmic topical preparations was independent of age, despite there being a non-significant tendency toward people from 18 to 50 years old to self-medicate in all three countries.
In our study, the major source of recommendation, with respect to which eye drop to buy for self-medication, was markedly different for each of the studied populations. In the Argentinean residents, the pharmacist, the patient’s personal decision and counseling from friends or family were the main reasons for drug misuse, with roughly the same percentages occurring for each of the three responses. In contrast, in Colombian patients, a friend or family suggestion seemed to be the most important motive in the election of which eye drop to obtain. On performing a comparative analysis between the variable “sources of recommendation” from the two studied groups, it could appreciated that Argentineans were significantly more likely to consider themselves qualified to decide which medication to use (p=0.001). In contrast, Colombian residents were significantly more accustomed to accepting the recommendation of a friend or a family member as the decisive influence for using a non-prescribed eye drop (p=0.001). Regarding the pharmacist as the source of reference, this was a common indicator in both populations (30.9% and 28.6% for Cordoba and Barranquilla, correspondingly) with a non-significant difference occurring between them (p=0.77).
The influence of the pharmacist’s opinions on patients in deciding which drug is useful for their complaint is well known all over the world, especially in Latin American countries [17
], with Pereira et al reporting in a population of Brazilian university students that 24.5% of the medicine used for self-medication was acquired by pharmacist's advice [18
]. Related to this, it is worth noting that the recommendation of drugs by the pharmacies is not permitted by law either in Brazil, in Colombia or in Argentina. Therefore, better control in drug selling may rationalize the utilization of ophthalmic medicines.
Johnson et al. [19
] stated that the practice of self-medication was frequent in a highly educated population of Oregon in the United States, thereby indicating that educational level could be a significant factor in the context of self-medication. However, in the present report, we studied people of different levels of education and did not find any statistical significant differences between dissimilar levels of instruction or between the same educational rank and different cities. In fact, we observed an opposite tendency in this matter, as despite showing that in the Argentinean population the most educated people tended to self-medicate, in the Colombian population less educated people practiced this method more often. These different trends could be due to many different causes such as greater or lesser access to ophthalmologists in different countries, differences in health coverage in each population or any other reason for which this study was not designed to investigate.
An important fact is that there are 489 ophthalmologists per million inhabitants in the city of Cordoba, while in Barranquilla this number drops to 51. Whereas the rate of self-medication found by us in these two populations was similar, maybe the number of ophthalmologists per million inhabitants is not a determining factor for this practice, at least in the studied populations.
In a study carried out in India by Rajani Kadri et al. about self-medication with OTC ophthalmic preparations, they found that different kinds of antibiotics were the drugs most frequently acquired by the study group, followed by unknown drugs at 35% and decongestant eye drops at 29% [20
]. This figure is very similar to the Colombian population, where antibiotics were the most commonly used medication, followed by a large population (18%) who did not remember the medication applied, with this last percentage of individuals who could not determine the type of drug utilized, being similar to that found among the Argentinean sample (14%). However, the most popularly used eye drop among the self-medicated people from Argentina at 32% was a decongestant in combination with a NSAID. It is noteworthy that in Argentina and Colombia there are few OTC eye preparations available, including some lubricants (artificial tears) and a decongestants in combination with NSAIDs eye drop.
A limitation of our study was the relative small number of patients in each group as well as the fact that the questionnaire was performed in patients that were visiting private eye clinics. As these were normally individuals with health insurance, as they were visiting private ophthalmology institutions, then the results might not be representative of all social strata. Future studies should include a more heterogeneous sample in order to reduce such bias. Another aspect to be considered is that, notably, there was a significantly lower recruitment in the Colombian group. This was due to the different number of patients attending this two institutions being almost twice in Argentinean clinic. Thus, by including in the sample only those patients attending for the first time to seek care, the Argentinean sample was larger than the Colombian one.
The safety of any drug is determined by two attributes: the intrinsic capacity of the drug to do harm and the quality of the information provided to the public about its use. Our study has demonstrated that not only are there 25% of people in both groups that self-medicated with eye drops, but also that there was a very low percentage of people who actually read the drug information leaflet. Consequently, a high percentage of self-medicated patients in both countries were not aware of the components present in used drops, and were therefore ignorant about all their possible ocular side-effects, thus making all these eye drops potentially unsafe for patient use.
Several factors in Latin Amercia, such as easy accessibility to a large number of drugs, the lack of official control over the marketing of these substances, the inherent weaknesses of health systems, the absence of the state as a source of information instructing about the risks of this custom, the influence of social environment and even cultural standards, contribute to the magnification and perpetuation of this manner. While it was not the purpose of this paper to investigate these aspects, there is no doubt that each of these factors influences the prevalence and the characteristics of self-medication in each of the studied populations. Further investigations oriented to explore these areas will be needed.