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BLOG: Let’s not forget about old faithful
The introduction of MIGS has significantly redirected the attention of ophthalmologists regarding the treatment of glaucoma. This area is exciting and holds promise as we attempt to help our patients maintain functional vision at a minimal risk. However, the current mainstay of treatment for most glaucoma patients still revolves around the use of eye drops. What I am so surprised to hear from other practitioners is the lack of awareness for eye drops that have been available for quite some time that can make a big difference in our care for these patients. I am referring to preservative-free formulations of glaucoma drops, including Zioptan (tafluprost, Akorn), Timoptic (timolol maleate) in Ocudose (Bausch + Lomb) and Cosopt PF (dorzolamide hydrochloride-timolol maleate, Merck).
The preservative-free subclass of eye drops is slowly gaining more popularity because it helps with improving patient compliance while still being able to decrease IOP by the desired amount. Although there are several reasons why patients do not use their drops, certainly ocular surface side effects, including eye irritation, redness and pain, are common. My experience with the use of preservative-free drops has shown to help reduce these side effects and, as a result, increase compliance.
With just these three options, any provider has the option of three classes of medication. This includes the gold standard in primary treatment with a prostaglandin analogue in Zioptan, an alternative to that or an addition as second-line therapy with a beta-blocker in Timoptic in Ocudose, or even a combination drop in Cosopt PF. This wide range of options provides the ability to use various classes but also the flexibility to tailor treatment as needed for each unique patient.
My view of using glaucoma drops is spun off from the economic law of diminishing returns. With all things being held constant, the addition of more drops gives less results in dropping IOP with each medication class added. As a rule, by the time I am having a discussion with patients needing more than just a single eye drop, whether that be in the form of another drop or laser trabeculoplasty, we are initiating the discussion of possible surgical intervention. The option of having three classes of preservative-free drops can in theory cover almost all patients being treated non-surgically.
However, I do understand we don’t work in a perfect system. One major hurdle to this or any medication will be the patient’s ability to obtain those, including issues revolving around cost. My hope is that more and longer use of these drops will help circumvent those issues. I have already noticed a difference in my practice.
The MIGS era has already begun and looks promising, but let’s not forget other options we have in our armamentarium that are safe and can improve our patients’ quality of life.
Disclosure: Teymoorian reports no relevant financial disclosures.