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Higher rate of OSD seen in patients on glaucoma agents
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In topical antiglaucoma therapy, the main factors impacting ocular surface disease were drops with preservatives, longer treatment duration and older age, according to research in the European Journal of Ophthalmology.
A total of 211 eyes from 211 patients with open-angle glaucoma or ocular hypertension on topical medication were enrolled with healthy controls from 51 eyes of 51 age- and sex-matched volunteers.
Main outcome measures were fluorescein corneal staining score, lower tear meniscus height (LTMH), noninvasive tear film breakup time (NI-BUT) and the Ocular Surface Disease Index (OSDI) questionnaire.
The medication group experienced significantly higher OSDI, at 10.24 vs. 2.5, and corneal staining of at least 1, 64.93% vs. 32.61%.
Researchers found that NI-TBUT and LTMH failed to vary between the groups.
In the medication group, researchers found correlations between benzalkonium chloride and BAK plus polyquaternium-containing drops or higher OSDI and abnormal corneal staining test results and between older age, longer treatment duration or corneal staining presence and a higher OSDI score.
Researchers found a higher prevalence of OSD in patients on IOP-lowering drugs than in healthy subjects.
The median OSDI score, despite being significantly higher in the medication group, did not fall within the range of abnormality, researchers confirmed.
They observed that not only BAK, but also the combination of BAK and PQ-1, elicited a 1.6 to 5.1 times greater likelihood, respectively, of showing corneal epithelial cell damage. – by Abigail Sutton
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Scott Anthony, OD, FAAO
The daily instillation of hypotensive eye drops in our glaucoma patients presents numerous challenges. It stands to reason that this protracted, repetitive process can adversely affect the ocular surface physiology and contribute to ocular surface disease.
In addition to the discomfort and redness caused by ocular surface disease, patient adherence to their glaucoma treatment plan is also negatively affected. Clinically, it is our responsibility to weigh the adverse effects of topical treatments with the disease severity and adjust our management strategy accordingly.
For glaucoma patients who develop ocular surface disease, I will look at a number of alternatives such as selective laser trabeculoplasty, switching to preservative-free or benzalkonium chloride-free alternatives, switching to brand-name drops and revisiting proper drop instillation technique to prevent overdosing. It is also important to keep in mind that patients may also have concomitant dry eye disease that must be addressed. At the end of the day the patient's IOP must be lowered, but we can adjust our management approach to keep our glaucoma patients as comfortable as possible for the long-term.
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