Switching to preservative-free formula may improve patient adherence, outcomes in glaucoma
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Switching to preservative-free topical formulations for glaucoma may improve patient adherence to treatment and improve symptoms and signs of ocular surface disease, according to a study published in Clinical Ophthalmology.
“Glaucoma requires the continuous long-term engagement of the patient with the recommendation proposed by the doctor and proper self-management to achieve the target IOP and prevent disease progression,” Sonja Jandrokovi, MD, PhD, of the University of Zagreb in Croatia, and colleagues wrote. “Hence, treatment success predominantly lies in patients’ adherence and persistence with therapy, which is related to many drug-related factors, such as side effects, cost and complexity of the dosing regimen.”
In a longitudinal, prospective interventional study, Jandrokovi and colleagues analyzed data on 36 adult patients with primary open-angle glaucoma (n = 28) or ocular hypertension (n =8) who were switched from preserved prostaglandin analog-timolol fixed combinations to preservative-free latanoprost-timolol fixed combinations (PF-LT) at baseline. Patients were evaluated at 30-day and 90-day follow-ups to assess efficacy on IOP reduction and local tolerance.
Outcomes of interest included changes in symptoms of ocular surface disease (OSD), drug tolerability, signs of OSD, tear film stability, visual function and the efficacy and safety of PF-LT in controlling IOP.
Researchers reported that IOP was significantly reduced from baseline to day 30 (16 mm Hg vs. 14 mm Hg, P < .001) compared with baseline. They also noted significant improvement in OSD symptoms, with median OSDI scores decreasing from baseline to the second and third visits (27.1 vs. 9.6 vs. 4.2, P < .001).
In addition, the number of patients with no OSD symptoms significantly increased, going from nine at baseline to 23 at 30 days and 27 at 90 days (P < .001). The number of patients with severe OSD symptoms decreased from 15 to three to two between visits (P < .001).
Researchers noted “a significant improvement” in the incidence and severity of all OSD signs from baseline to the second and third visits, the most significant of which included conjunctival hyperemia, eyelid and periocular hyperemia, and fluorescein ocular surface staining.
Subjective drug tolerability also increased from baseline to follow-up visits (P < .001), although post-hoc analyses indicated no significant change in drug tolerability between the second and third visits.
Further, researchers reported significant increases in tear breakup time (4 vs. 5 vs. 6 seconds, P < .001) and visual analog scale score regarding tolerability (5 vs. 2 vs. 1, P < .001).
“The beneficial effects of switching to unpreserved medication might affect patient adherence and persistence with therapy and impact therapy outcomes, and therefore suitable for all glaucoma patients,” Jandrokovi and colleagues wrote.
Perspective
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Eye drops. Whether you love them or hate them, topical therapy has been the beloved treatment modality for glaucoma in our lifetime. The gold standard. First-line therapy. A mainstay of glaucoma. Yet, times may be changing. Years and years of eye drop use have confirmed the toxic nature of preservatives, continued issues with adherence and a significant cost barrier for the majority of our patients.
In this longitudinal, prospective study, Jandrokovich and colleagues have unsurprisingly suggested that a switch from a preserved prostaglandin-timolol fixed combination drop to a preservative-free prostaglandin-timolol drop improved patient tolerability, adherence and IOP control.
At this point, there shouldn’t be any doubt that preserved eye drops, especially those with BAK, are toxic to the eye, but in the U.S. there are still limited options for nonpreserved and BAK-free options. As well, the use of selective laser trabeculoplasty, as supported by the outcomes of the LiGHT trial, and new-to-market alternative drug delivery systems are beginning to diversify our arsenal and treatment protocols. Our time and efforts should continue to be directed to finding a reliable, non-toxic and cost-effective therapy for our patients.
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