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BLOG: Look for surface inflammation before treating glaucoma
Anything that you do to the ocular surface can create a dry eye that may not have been present previously or create symptoms from an indolent dry eye that had not been a problem prior. Most of us who treat dry eye also treat glaucoma patients. We can apply some of our dry eye expertise in our glaucoma patients in an effort to provide better glaucoma care.
The signature breakthrough in dry eye diagnostics is the point-of-service test. The advent of tear osmolarity, surface inflammatory activity testing and meibomian gland imaging has forever changed the treatment of dry eye. We can expect that this trend will begin to extend both on the ocular surface (allergy testing, glucose levels) and in other areas of ophthalmology. The first “crossover” test from one area of care to another is probably the use of OCT by cataract surgeons to diagnose heretofore unseen macular pathology preoperatively, a test that influences IOL choice.
In a similar vein, let me propose that we consider using InflammaDry (RPS) on our new glaucoma patients before choosing our initial therapy. Many (most?) topical glaucoma medications have at least the potential to cause pretty much every dry eye symptom you can think of. It makes sense that at least some of this is the result of ocular inflammation. If inflammation is already present, it also makes sense that we should try to avoid increasing that inflammation. I’d like to propose that we do an InflammaDry test on newly diagnosed glaucoma patients in whom we plan to initiate treatment.
How would this look? It’s pretty straightforward, I think. If the InflammaDry is negative, then the presentation of options to the patient includes both topical medication and selective laser trabeculoplasty. However, if the InflammaDry is positive, it makes all the sense in the world to choose SLT as the preferred first-line treatment. In time, as we get more types of treatment that do not include topical medication (intravitreal injection, MIGS), the use of InflammaDry as a precursor to glaucoma treatment will become even more valuable.
Disclosure: White reports he is a consultant for Bausch + Lomb, Allergan, Shire and Eyemaginations and on the speakers board for Bausch + Lomb, Allergan and Shire.