Évaluation de la sensibilité cornéenne chez les patients traités médicalement pour un glaucome ou une hypertonie oculaire

Went, C. Van; Alalwani, Haiyan; Brasnu, Emmanuelle; Pham, Jocelyne; Hamard, P.; Baudouin, Christophe; Labbé, Antoine

doi:10.1016/j.jfo.2011.07.011

Cited by 28 publications

(15 citation statements)

References 31 publications

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“…There are different findings in symptoms and signs of dry eye between glaucoma-treated patients and controls in various studies. Similar to our results, Van Went et al16 also found that only TBUT and fluorescein staining grade were significantly altered in treated patients as compared to untreated control group, but there was no significant difference for Schirmer test and OSDI. Some studies1,6,17,18 reported significantly shorter TBUT and Schirmer test, whereas others12,19 did not find any significant changes in these two clinical tests in patients treated with BAK-preserved medications.…”

Section: Discussionsupporting

confidence: 91%

“…However, there are natural fluctuations of symptoms during the day and patients reported increased dry eye symptoms during some activities, such as TV watching and driving in the evening rather than in the morning 13,30. Lack of correlation between signs and symptoms may be caused by decreased corneal sensitivity by BAK-preserved eye drops 16,17,31. In vivo confocal microscopy demonstrated a significantly lower density of subbasal corneal nerves in patients taking preserved glaucoma medications compared to both those on preservative–free medication and the control group 17.…”

Section: Discussionmentioning

confidence: 99%

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Symptoms and signs of ocular surface disease related to topical medication in patients with glaucoma

Cvenkel¹,

Stunf²,

Kirbiš³

et al. 2015

OPTH

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PurposeThe aim of this study was to assess signs and symptoms of ocular surface disease (OSD) and the cytomorphological changes of ocular surface in glaucoma patients using preserved antiglaucoma drops.MethodsIn this cross-sectional study, 109 participants (79 patients with topical medication and 30 untreated controls) completed the Ocular Surface Diseases Index (OSDI) questionnaire and underwent an ophthalmic examination, including Schirmer test, tear film breakup time (TBUT), and fluorescein staining. Conjunctival specimens were collected by impression cytology and analyzed by light microscopy using Nelson’s grading scheme (grades 0–3). This classification is based on the nucleus-to-cytoplasm ratios of epithelial cells and the numbers of goblet cells, with grade 2 considered abnormal.ResultsThe medication group had significantly shorter TBUT (median [interquartile range]: 6.0 seconds [5.0–8.0 seconds] vs 9.5 seconds [6.0–12.3 seconds]; P<0.03), greater fluorescein staining (1.0 [0.75–1.25] vs 0 [0–0.25]; P<0.001), and higher impression cytology grade than the control group (median [range]: 1.0 [1:2 to 1:6] vs 0.6 [1:2 to 1:4]; P<0.001). The increasing number of drops instilled per day was associated with an increase in fluorescein staining (Spearman’s rho r=0.475; P<0.001) and shorter TBUT (r=−0.278; P=0.014). The OSDI did not discriminate between the two groups.ConclusionClinical tests and impression cytology showed ocular surface damage in patients using preserved antiglaucoma medications. However, there was no statistically and clinically significant difference in symptoms measured by OSDI score between the medication and control groups.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Symptoms and signs of ocular surface disease related to topical medication in patients with glaucoma

Cvenkel¹,

Stunf²,

Kirbiš³

et al. 2015

OPTH

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“…One unifying hypothesis is that IOP-lowering medication use may lead to punctate epithelial erosions and a subsequent decrease in corneal sensitivity, therefore masking symptoms and explaining the similar prevalence of ocular discomfort–related symptoms. 35,36 Our study also confirms the discordance between patient-reported symptoms and clinical evaluations when detecting ocular surface disease. 33,37 A similar explanation has been invoked for other conditions such as diabetic retinopathy, where a decrease in corneal sensitivity most likely contributes to the lack of ocular discomfort symptoms.…”

Section: Discussionsupporting

confidence: 73%

Evaluation of Ocular Surface Disease in Patients with Glaucoma

et al. 2013

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Purpose To evaluate the subjective and objective measures of ocular surface disease in patients with glaucoma. Design Cross-sectional study. Participants Sixty-four glaucoma subjects with bilateral visual field (VF) loss and 59 glaucoma suspects with normal VFs. Methods Consecutive patients were recruited prospectively from the Wilmer Eye Institute Glaucoma Clinic. Main Outcome Measures Tear film breakup time (TBUT), corneal staining score (0–15), and Schirmer’s test results were included as objective metrics, whereas the Ocular Surface Disease Index (OSDI) questionnaire was administered to assess symptoms. Total OSDI score, vision-related subscore (derived from questions about vision and task performance), and discomfort-related subscore (derived from questions about ocular surface discomfort) were calculated for each subject. Results Seventy-five percent (48/64) of glaucoma subjects and 41% (24/59) of glaucoma suspects were receiving topical medications. The corneal staining grade was greater in glaucoma subjects than in glaucoma suspects (6.4 vs. 4.1; P<0.001), but groups did not differ with regard to TBUT or Schirmer’s results (P>0.20 for both). Multivariate regression models showed that topical glaucoma therapy burden was associated with a significantly higher total corneal staining grade (β, +0.9 for each additional glaucoma drop; 95% confidence interval [CI], 0.5–1.3; P<0.001), but not with TBUT or Schirmer’s results (P>0.20 for both). Glaucoma subjects had significantly higher total OSDI scores than glaucoma suspects (16.7 vs. 7.9; P<0.001). This largely was the result of higher vision-related subscores in the glaucoma group (11.1 vs. 3.3; P<0.001). Ocular discomfort–related subscores, however, were similar in both groups (5.7 vs. 4.6; P = 0.30). In multivariate analyses, each 5-decibel decrement in better-eye VF mean deviation was associated with a 4.7-point increase in total OSDI score (95% CI, 1.9–7.5; P = 0.001) and a 3.7-point increase in the vision-related subscore (95% CI, 1.7–5.6; P<0.001) but did not predict a higher discomfort-related subscore (β, 1.1 point; P = 0.07). Topical glaucoma therapy burden was not associated with higher total OSDI score or vision- or discomfort-related subscore (P>0.20 for all). Conclusions Glaucoma is associated with significant ocular surface disease, and topical glaucoma therapy burden seems predictive of corneal staining severity. However, OSDI is a poor metric for capturing ocular surface disease in glaucoma because symptoms seem to be related largely to VF loss.

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“…In addition, the great majority (94%) of the treatments used by patients in the current study contained preservatives that, as well as being responsible for much of their toxicity, may cause a degree of local corneal anesthesia that masks symptoms of ocular surface disease. 24 , 25 Questioning patients regarding adverse effects of glaucoma treatment may, therefore, be an unreliable means of establishing the presence of ocular surface disease associated with glaucoma treatment. Such occult ocular surface disease may have serious consequences if allowed to develop over the extended time scales required in glaucoma treatment.…”

Section: Discussionmentioning

confidence: 99%

Patient satisfaction with glaucoma therapy: reality or myth?

Lemij

Hoevenaars

Windt

et al. 2015

OPTH

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While safe and effective treatments for glaucoma exist, their effectiveness is compromised by poor compliance. Patients who have problems with their topical glaucoma medication are acknowledged to be at higher risk for poor compliance, frequent medication switching, and surgery. Patient satisfaction with therapy and its associated benefits have until recently taken second place to efficacy. The present study is a transverse cross-sectional epidemiological survey among glaucoma patients receiving therapy with prostaglandin analogs. The primary objective was to determine and characterize patient satisfaction with glaucoma therapy, and the secondary objective was to identify factors that may contribute to poor patient satisfaction. Ophthalmologists in the Netherlands included 199 patients and 164 were analyzed. Patients were predominantly elderly with early, primary, open angle glaucoma. Eighty-nine percent of them stated they were satisfied or very satisfied with their treatment. However, signs of ocular surface disorder on ophthalmological examination were evident in 44% of patients, corneal fluorescein staining was positive in 28% of patients, and 38% of patients were using tear substitutes. The prevalence of blepharitis/meibomian gland dysfunction and dry eye was more than twice as high after the commencement of therapy compared with before therapy. Univariate analysis revealed that patient dissatisfaction with their glaucoma therapy was statistically significantly (P<0.001) associated with the presence of ocular surface disease, hyperemia, ocular signs, symptoms upon and between instillation, and the use of tear substitutes. Apparently, patients in the present study are satisfied with their treatment; 89% expressed satisfaction compared with only 11% who professed dissatisfaction. The results suggest that even if local adverse events and ocular surface disease, in particular, contribute to glaucoma patient dissatisfaction, only a minority of patients expressed such dissatisfaction. At the time of the study, most (94%) of the patients included were receiving preserved preparations. Further studies should evaluate the influence of preservative on patient satisfaction.

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Évaluation de la sensibilité cornéenne chez les patients traités médicalement pour un glaucome ou une hypertonie oculaire

Cited by 28 publications

References 31 publications

Symptoms and signs of ocular surface disease related to topical medication in patients with glaucoma

Symptoms and signs of ocular surface disease related to topical medication in patients with glaucoma

Evaluation of Ocular Surface Disease in Patients with Glaucoma

Patient satisfaction with glaucoma therapy: reality or myth?

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Évaluation de la sensibilité cornéenne chez les patients traités médicalement pour un glaucome ou une hypertonie oculaire

Cited by 28 publications

References 31 publications

Symptoms and signs of ocular surface disease related to topical medication in patients with glaucoma

Symptoms and signs of ocular surface disease related to topical medication in patients with glaucoma

Evaluation of Ocular Surface Disease in Patients with Glaucoma

Patient satisfaction with glaucoma therapy: reality&nbsp;or myth?

Contact Info

Product

Resources

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Patient satisfaction with glaucoma therapy: reality or myth?