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Study shows high rate of OSD in glaucoma patients
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Patients with glaucoma have significantly worse ocular surface disease signs and symptoms and worse quality of life as compared with cataract patients, according to a study.
Glaucoma medications are likely to be the main cause of these problems, the authors said.
Both the active principle and the preservatives used in eye drops can cause or aggravate changes in the ocular surface, which affect patients’ quality of life and adherence to the therapy, the authors noted. In a study, they compared both eyes of 30 patients with open angle glaucoma and 27 patients with cataract. Glaucoma patients were using at least one IOP-lowering medication for at least 6 months.
The presence of ocular surface disease (OSD) was evaluated by ophthalmic examination including measurement of tear break-up time (TBUT), assessment of conjunctival hyperemia and keratitis, and completion of the Ocular Surface Disease Index (OSDI) questionnaire. Objective ocular surface analysis was performed using the Keratograph 5M (Oculus) to measure tear meniscus height (TMH), bulbar redness (BR), noninvasive TBUT (NIKBUT) and loss of meibomian glands by meibography.
Keratitis and conjunctival hyperemia were worse in the glaucoma group and, according to the OSDI questionnaire, the overall prevalence of OSD was 71%, compared to 29% in the cataract group. Keratograph assessment showed significantly smaller TMH, worse BR, greater loss of meibomian glands and worse NIKBUT in eyes with glaucoma. Regarding quality of life (QoL), assessed by the NEI VFQ-25 questionnaire, subjects with glaucoma had a significantly lower score than subjects with cataract.
“These findings indicate that patients with glaucoma may have significant clinical symptoms of OSD, and these may be related to treatment,” the authors wrote.
They hope that objective evidence of the alterations of the ocular surface in glaucoma patients will help increase the awareness about the importance of their complaints, “so that the possible complications of dry eye can be treated and so that a better QoL for patients with this chronic disease who need to use medications for a long period of time can be promoted.”– by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.
Perspective
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Mark Eltis, OD, FAAO
Because glaucoma is a symptomless disease in the initial stages, adverse reactions from treatment of an “invisible” problem can result in poor treatment adherence. This study quantifies the effects of OSD in patients taking glaucoma medications. Not surprisingly, the authors found that glaucoma sufferers may have significant signs and symptoms of OSD that can affect their quality of life. In fact, previous research shows that up to about half of glaucoma sufferers may have OSD.
The good news is that optometrists play a key role in improving patient adherence to glaucoma medication and raising their quality of life by addressing their dry eye concerns. Even in jurisdictions without glaucoma prescribing rights, optometrists can make a significant contribution in the fight against a leading cause of blindness. Optometric glaucoma doctors can go one step further in recommending medications that are less likely to irritate the ocular surface. Consequently, we must make increasingly difficult and more expensive choices regarding equipment. The keratograph used in this study is particularly significant, as it highlights the intersection of advanced dry eye diagnostics and glaucoma management. Whether you take a high-tech or more conventional approach, you are wise to consider OSD when seeing your glaucoma patients.
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