Short-term OSD treatment may not alter glaucoma patients’ regimen
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Recent data showed a greater incidence of ocular surface disease symptoms in patients receiving medical treatment for glaucoma, according to a study published in Clinical Ophthalmology.
Researchers also identified that while short-term treatment of ocular surface disease (OSD) could be beneficial for the disease and IOP, it would not affect continued use of glaucoma medications.
Ana Luiza Mylla Boso, MD, of the department of ophthalmology and otorhinolaryngology at the Federal University of Santa Catarina in Brazil, and colleagues sought to evaluate the presence of OSD in patients with glaucoma who were using topical treatment, in addition to quantifying symptoms and objective ocular surface parameters. They also examined the impact of ocular surface treatment on OSD and IOP.
Researchers analyzed data from 19 patients with primary open angle or primary angle closure glaucoma who received topical treatment for at least 6 months. They screened patients for symptoms using the ocular surface disease index (OSDI) questionnaire.
Boso and colleagues identified 73.68% of patients reported severe symptoms of dry eye disease, with OSDI scores higher than 33 at baseline. They found tear film instability in 50% of patients, while 23.53% had severe meibomian gland abnormalities.
The investigators also reported abnormal fluorescein (88.24%) and lissamine green (82.35%) stainings.
Following treatment of the ocular surface, Boso and colleagues found improvement in best-corrected visual acuity (P = .0003) and OSDI score (P < .0001). They also saw improvement in bulbar redness (P = .0196) and fluorescein staining (P < .0001).
Mean IOP after ocular surface disease treatment was lowered by –1.59 mm Hg from baseline in the left eye (P = .051), the researchers wrote.
“This study showed a detailed characterization of OSD related to glaucoma eyedrops and the positive impact of a comprehensive ocular surface treatment, raising concerns and important awareness for both glaucoma and ocular surface practices,” Boso and colleagues wrote.
Perspective
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Ellen Shorter, OD, FAAO
Glaucoma management often requires lifelong use of topical medications. Many glaucoma medications continue to use benzalkonium chloride (BAK) preservative, which can exacerbate OSD. Special attention should be focused on OSD signs and symptoms when evaluating patients using IOP-lowering medications. Patients with glaucoma frequently experience discomfort and ocular redness.
In this study, the researchers instructed established patients using an average of three anti-glaucoma medications to incorporate lid hygiene, preservative-free artificial tears, topical corticosteroid, oral doxycycline, oral omega-3 and oral flaxseed oil supplementation daily. After about 2 months, ocular surface disease symptoms, ocular redness, corneal fluorescein staining and best-corrected visual acuity were improved.
In addition to limiting preservative toxicity when possible, simple adjustments can be made to improve both clinical signs and symptoms by addressing co-existent OSD. Further long-term studies are needed; however, this study provides support for implementation of aggressive OSD management in patients with glaucoma.
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