Q&A: Clinicians need to understand effect of hyperemia on patients with glaucoma
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Hyperemia, a side effect of some glaucoma medications, may cause patients to pause their treatments, according to a survey conducted by Bausch + Lomb and the Glaucoma Research Foundation.
The survey, designed to improve the understanding of hyperemia, included 101 adults with glaucoma who had previously experienced hyperemia as a result of their treatment. Sixty-one percent of patients reported that they did not know what hyperemia was before they experienced it themselves.
Forty-three patients reported that they had spoken with their doctors about wanting to change their medication due to the side effect, while 12 said that they had skipped doses or stopped using their drops. One in 10 patients said they stopped their treatment during certain social or professional interactions.
Healio/OSN spoke with Andrew G. Iwach, MD, board chair of the Glaucoma Research Foundation and executive director of the Glaucoma Center of San Francisco, to find out what impact these treatment interruptions might have and what physicians can do to help.
Healio/OSN: What is hyperemia, and what are the causes?
Iwach: From the patient’s perspective, it is a red eye. There are a lot of possible causes for red eyes, from infection and allergic reaction to drug reaction. In the context of this survey, some of the glaucoma medications we use can cause this red eye or hyperemia.
Sometimes, it is caused by a preservative such as benzalkonium chloride or, more commonly, a glaucoma medication such as brimonidine or the newer Rho kinase inhibitors.
I was not surprised to see the results of this survey. I deal with this all the time in my clinic, but there are options. Bringing this to the attention of not only the public, but to my colleagues, is an important part of addressing the issue.
OSN: What are the consequences of skipping or stopping glaucoma medications?
Iwach: Glaucoma is not like an infection in which you are taking an antibiotic for a week or 10 days. In glaucoma, you are looking at not weeks or months but years of management. If you do not consistently keep the pressure down, you increase the risk for damage to the optic nerve. The Glaucoma Research Foundation is funding research at a high level to reverse that damage, but we are not there yet. The more we can keep the pressure in a safe range, the better.
The reason we do screening programs to identify patients with glaucoma is because early on in the disease, there are no symptoms. All the while, this disease is slowly damaging the optic nerve and creating permanent damage. We want to find solutions that keep our patients seeing for the rest of their lives while minimizing the impact on their quality of life. That is where hyperemia becomes concerning.
OSN: Is there any way to treat hyperemia, and what can physicians do to help their patients?
Iwach: The first step is identifying and acknowledging the problem. Theoretically, you could use another drug to treat the side effect of hyperemia, but it is much better to shift to another option. The good news is that in glaucoma, we have a number of different options.
One of the quickest ways to be a hero for your patient is to be observant and ask questions. I was in the clinic recently and noticed that a patient had red eyes, so I asked, “Does that bother you?” Turns out it did, and I shifted the patient to a different treatment option. It can be a two-way approach. We want to empower patients to know that if they have a side effect, they can bring it to the attention of the clinician. As a clinician, it is better yet when we bring it up first.
Red eyes are hard to hide. You can hide your mouth or your nose with a mask, but your eyes are still there.
- Reference:
- New survey from Bausch + Lomb and Glaucoma Research Foundation reveals emotional and social impact of hyperemia on glaucoma patients. www.bausch.com/our-company/recent-news/artmid/11336/articleid/683/01042022-tuesday. Published Jan. 4, 2022.
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