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Switch from preserved to unpreserved glaucoma drug
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Switching to preservative-free tafluprost for long-term glaucoma therapy led to improved tear film thickness, breakup time and Dry Eye-Related Quality-of-Life Score, according to a recent study.
The cohort was made up of 30 patients between 68 and 84 years old who were on topical preservative-containing prostaglandin monotherapy for at least 6 months and then switched to unpreserved tafluprost drops once daily.
Patient IOP was 21 mm Hg in the study eye at the screening examination, and TBUT was 10 seconds.
Researchers measured tear film thickness (TFT) at baseline and at 4 and 12 weeks after therapy change using an ultra high-resolutionOCT system. Researchers chose the eye with the lower tear film thickness as the study eye.
TBUT was measured following the guidelines in the Dry Eye Workshop report. Symptoms of dry eye were assessed using the Ocular Surface Disease Index (OSDI). The 15-item DEQS questionnaire was used to assess change in patient quality of life.
After switching to unpreserved tafluprost, TFT significantly increased from 4.7 µm after 4 weeks and was often increased after 12 weeks, reaching 4.8 µm; however, the last visit was not statistically significant, according to researchers.
TBUT significantly increased from 5.1 seconds at baseline to 7.2 seconds after 4 weeks and to 10.1 seconds after 12 weeks of unpreserved tafluprost. Researchers noted a significant decrease in corneal staining score from 1.8 at baseline to 1.4 after 4 weeks and to 0.7 after 12 weeks of treatment.
Switching to preservative-free drops reduced DEQS from 11.4 to 5.7 and 4.7. In addition, researchers reported that ocular comfort assessed as symptoms of ocular surface disease improved as well, and OSDI tended to decrease over time. Osmolarity did not change significantly over time.
Researchers concluded that switching from preserved anti-glaucoma treatment to preservative-free tafluprost leads to an increase in TFT after 4 weeks.
There is increasing evidence that long-term exposure to preservatives impact the health of the ocular surface, they wrote.
Researchers also noted that no change in IOP was observed, which is in line with previous published results, “indicating that the IOP-lowering capacity of preservative-free prostaglandin eye drops is not inferior to that of preserved formulations.” – by Abigail Sutton
Disclosures: The study was supported by Santen. Hommer is a consultant for Santen and receives speaker fees from the company. Please see the full study for all remaining authors’ financial disclosures.
Perspective
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Derek MacDonald, OD, FAAO
As clinicians managing glaucoma, it’s important that we treat the patient, not the pressure. Our goal is not simply to get the IOP as low as possible; it’s to enhance quality of life by preserving vision without causing intolerable side effects from treatment.
Given that topical agents remain the cornerstone of medical management, preservative exposure is often the bane of those being managed and those doing the managing. Long-term exposure to benzalkonium chloride (BAK) has proven toxic to the cornea, conjunctiva and trabecular meshwork and increases the risk of failure of filtration surgery. Further, ocular surface disease decreases treatment adherence and persistence, and drugs don’t work for patients who don’t take them.
Fortunately, preservative-free (or BAK-free) medications are available in a number of drug classes, including prostaglandin analogs (PGAs) and fixed combinations. Hommer and colleagues have shown that preservative-free tafluprost decreases corneal staining and improves tear film thickness, tear break-up time and vision-related quality of life, all while lowering IOP as effectively as a preserved PGA. Management of a disease that may begin as asymptomatic but is potentially blinding must be effective, convenient and tolerable; preservative-free treatment options are a critical means to that end.
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