We aimed to analyze and model the cost and results of current outpatient pharmacotherapy practice in patients with primary open-angle glaucoma concomitant with dry-eye disease (POAG+DE). The point of view is that of the health care system and patients, and the time horizon was 1 year. Data were collected through a prospective, observational, real-life study of therapy practice in patients admitted to the specialized ophthalmology clinic at the Alexandrovska University Hospital in Sofia. Pharmacotherapy was recorded and analyzed by therapeutic group and INN. The probability of being prescribed preservative-free or non-free formulations was calculated, as were the cost of yearly therapy, reimbursed cost, and patient co-payment. A decision tree exploring the cost-effectiveness of preservative-free and preservative non-free formulations was built. Outcomes were recorded through three tests measuring tear film stability: TMS, NIBUT Ave, and ST. TMS values below 3, ST above 10 mm, and NIBUT Ave above 14 s were considered as indicators of good disease control. A total of 140 eyes were diagnosed with POAG, of which 64 had concomitant dry-eye disease and were included in the analysis. Monotherapy was prescribed to 34: 14 on preservative-free formulations and 20 on nonfree. Meanwhile, 30 eyes received combination therapy: six on preservative-free and 24 on non-free. The monotherapy product was most commonly Prostaglandin Analogs (PG-−73.5%), followed by beta-blockers (BB−26.5%). No carbonic anhydrase inhibitors (Ca AA) or alpha-2 adrenergic agonists (alfa 2 AA) were prescribed as monotherapy. The majority of patients showed poor disease control according to all three measures. The incremental cost-effectiveness ratio (ICER) was 744 BGN for TMS and 131 BGN for NUBIT for each successfully controlled eye-far below three times GDP per capita. For ST, the ICER was negative, benefiting non-free formulations. Therapy of POAG+DED with preservative-free formulations is cost-effective according to the WHO threshold of three times GDP. The median costs of the two treatment modalities were similar. Current practice shows that patients experience a higher burden in terms of co-payment than do institutions such as the NHIF.

Objectives: To investigate and compare the tear volume, tear film stability, Meibomian gland loss of healthy and glaucoma subjects from the Bulgarian population and to assess the relationship between clinical findings and glaucoma therapy. Methods: In this observational cross-sectional study, a random cohort of 68 subjects was enrolled and divided into patients with primary open-angle glaucoma or ocular hypertension (POAG/OHT group; n=19) and healthy controls (HC group; n=49). Ocular surface was analysed objectively by Noninvasive tear Break-Up Time (NIBUT), Meibomian gland loss, and Schirmer test for basal secretion. In addition, Central Corneal Thickness (CCT) was measured with pachymetry. Results: Loss of Meibomian glands (39.85% ± 14.49%), as well as a decrease in Schirmer test values (7.29 mm ± 3.92 mm) and NIBUT (8.26 s ± 4.73 s), were typical in the POAG/OHT group, regardless of disease duration. Significant factors affecting the ocular surface state were age, anti-glaucoma treatment (type and duration), and the presence of preservatives. A worsening of all clinical parameters was evident in the glaucoma patients. A correlation between CCT and NIBUT was established (p=0.037; r=0.167). Conclusions: Local glaucoma treatment affects the ocular surface objective parameters according to its duration and the composition of treatment eye drops.

Purpose: To determine whether the wearing time of contact lenses affects the condition of the meibomian glands and the tear film breakup time. Material and methods: This is a cross-sectional study involving 150 eyes ( 75 patients) with an age between 18 to 65 years. Five groups were allocated, with distribution criteria being the soft contact lenses wearing time: up to 5 years, from 6 to 10 years, from 11 to 20 years and more than 20 years. All subjects used soft contact lenses daily, at least 5 hours a day and 4 days a week. All patients underwent a thorough ophthalmic examination and non invasive tear film breakup time (NIBUT), and meibomian gland loss (MGL) investigated with Oculus Keratograph 5 M. Results: A statistically significant relation with the soft contact lenses wearing time has been found for the indicator MGL,% (U) (p = 0.025). In the general study of male and female patients, a significant association was only observed in female patients (p = 0.04). A statistically significant relation to the soft contact lenses wearing time has been found for the indicators NIBUT 1, s ( P=0.035) и NIBUT Av, s ( P=0.023). The same relation has been found only in female patients - NIBUT 1, s ( P=0.035] и NIBUT Av, s ( P=0.023). Conclusion: Long-term contact lenses wearing is proportional to the change in gland function and may contribute to the development of dry eye syndrome.

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An increasing amount of data suggests a role of the eye vascular system and oxidative stress in glaucoma pathogenesis. Reports have suggested endothelin-1 (ET-1) and its receptor (ETR-A) as possible glaucoma biomarkers. This study explored the diagnostic and prognostic abilities of ET-1 and ETR-A plasma concentrations in primary open angle glaucoma (POAG). Seventy-five participants were divided into three groups: controls, early and advanced POAG stage, graded by a perimetric visual field test. All of them underwent a standard ophthalmological examination including optical coherence tomography. The statistical analysis showed a significant difference between the ET-1 values in the controls (4.88 ± 1.75 pg/mL) and the glaucoma patients, but lack of statistical significance in the glaucoma severity (early POAG: 6.33 ± 2.38 pg/mL and advanced POAG: 6.34 ± 1.56 pg/mL). The mean ETR-A values were significantly different between the three groups (controls 1209.28 ± 314.48 pg/mL, early POAG: 673.44 ± 283.02 pg/mL and advanced POAG: 992.28 ± 264.22 pg/mL). Two mathematical models were developed concerning the two perimetric indices (MD/PSD) and ETR-A in the early glaucoma group. ETR-A showed a very high diagnostic accuracy. Only ETR-A had significant diagnostic ability for advanced glaucoma after the comparison between the two glaucoma groups. Every 1 pg/mL increase in the ET-1 plasma concentration increased the possibility for early glaucoma changes by 2.124 times, whereas every 1 pg/mL increase in the ETR-A level decreased this possibility by 1%. Our results indicate that ET-1 and ETR-A could be two very good diagnostic parameters for early POAG changes.