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Presenter: Reduce the dry eye burden in glaucoma therapy
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CHICAGO – “We have good glaucoma medications. Each is a tool, but they’re a tool with cutting edges,” Robert D. Fechtner, MD, told attendees at the Optometric Glaucoma Society meeting, held prior to the American Academy of Optometry meeting.
“We should be reducing the iatrogenic dry eye burden we’re creating,” he continued. “We can do that if we can better define the risk factors of patients when they walk in the door. Use a survey tool or exam. Recognize them as someone we may tip over the edge a little sooner than otherwise.”
Studies have shown that between 50% and 60% of patients with glaucoma have mild to severe ocular surface disease (OSD) symptoms, Fechtner said.
“There’s got to be something going on in treated glaucoma patients that’s leading to this high prevalence of OSD,” he said. “We need to be thoughtful as we’re loading patients up with the therapy we believe they need to improve their vision. Is the medication you prescribe not detracting from quality of life, or minimally impacting it? Is the cost-benefit ratio worth it in the patient’s perception?”
Fechtner referred to a patient taking three glaucoma drops, plus pills, as a “bad idea.”
“When you’re about to prescribe the second drop, think about it,” he said. “Laser trabeculoplasty is something we’re not using early enough in our treatment regimens.”
Fechtner recommended discussing the pros and cons of using multiple drops and the potential associated OSD vs. surgery.
“There’s the preservation of vision part and a quality of life part,” he said. “It’s a little harder to therapeutically manage quality of life, but you need to discuss these things with patients and have them make a choice.”
He also stressed the importance of detecting dry eye disease prior to surgery.
“Don’t let patients get to the operating room with a disruptive tear film and cornea,” he said. – by Nancy Hemphill, ELS, FAAO
Reference:
Fechtner R. Ocular surface disease and topical glaucoma therapy. Presented at: Optometric Glaucoma Society; Chicago; Oct. 10, 2017.
Disclosure: Fechtner reported no relevant financial disclosures.