Glaucoma therapy and ocular surface disease

Anwar, Zane; Wellik, Sarah R.; Galor, Anat

doi:10.1097/icu.0b013e32835c8aba

Cited by 93 publications

(35 citation statements)

References 57 publications

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“…The study was a retrospective evaluation of routine visits performed using slit-lamp examination and, at discretion of the physician, dying with fluorescein to evaluate parameters related to dry eye (break-up time, epithelial staining, and clearance of fluorescein). Due to the use of low-tech methods, underestimation of conditions such as DED, particularly in asymptomatic cases, is extremely likely; moreover, the population of this study is not fully representative of the whole population, as in our clinic, patients with glaucoma or corneal pathologies (who have a very high prevalence of OSD [12, 15, 16]) are directly referred to tertiary services. Nevertheless, we found a prevalence of OSD of about 10%, which is confirmatory of the literature.…”

Section: Discussionmentioning

confidence: 99%

Age-Related Changes of the Ocular Surface: A Hospital Setting-Based Retrospective Study

Ottobelli

Fogagnolo

Guerini

et al. 2014

Journal of Ophthalmology

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Purpose. To investigate the effects of age on the prevalence of ocular surface diseases (OSD), adherence to treatment, and recovery rates. Patients and Methods. Retrospective analysis of 3000 clinical records from a first-level general ophthalmology clinic. Patients with OSD were prospectively submitted a questionnaire to assess compliance and recovery rates. Results. OSD prevalence was 10.3%. Patients with OSD were significantly older than patients without it: 67.5 ± 20.3 versus 57.0 ± 22.0 years (P = 0.036). No significant difference in season distribution was shown. Dry eye disease (DED) represented 58% of OSD; its prevalence increased with age until 80 years old and suddenly decreased thereafter. Asymptomatic DED was 37%. Adherence to treatment in OSD was very high (94%); recovery rates were lower in patients aged 21–40 and 61–80 (resp., 65.5% and 77.8%) and this was associated with higher OSDI scores. Tear substitutes represented 50% of all prescribed medications; their use increased with age. Discussion. In a “real-life” low-tech setting, OSD showed a prevalence of 10.3%. DED was the most prevalent disease, and it was asymptomatic in more than 1/3 of cases.

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Section: Discussionmentioning

confidence: 99%

Age-Related Changes of the Ocular Surface: A Hospital Setting-Based Retrospective Study

Ottobelli

Fogagnolo

Guerini

et al. 2014

Journal of Ophthalmology

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“…Glaucoma and dry eye are prevalent conditions that often coexist in patients [1]. Glaucoma affects more than 60 million people worldwide and even mild disease has a significant impact on quality of life (QoL) [2,3].…”

Section: Introductionmentioning

confidence: 99%

Dry eye specific quality of life in veterans using glaucoma drops

Camp

Wellik

Tzu

et al. 2015

Contact Lens and Anterior Eye

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Purpose To evaluate the frequency of ocular surface symptoms and their potential impact on dry eye specific quality of life (QoL) in patients using versus not using glaucoma medications. Material and methods The study was a single-center, cross-sectional survey of patients seen at the Miami Veterans Affairs (VA) ophthalmology and optometry clinics from June to August, 2010. Patients were invited to complete the Dry Eye Questionnaire 5 (DEQ5) and the Impact of Dry Eye on Everyday Life (IDEEL) at their visit. Of 1348 patients seen in the Miami VA eye clinics during this three-month period, 467 patients completed the DEQ5 and 391 responded to both questionnaires. Outcome measures comprised ocular surface symptoms and their impact on dry eye specific QoL in patients using versus not using glaucoma drops. Results An increasing number of glaucoma drops was significantly associated with an increased percentage of severe dry eye symptoms: no medications, 25% (n = 89/353); 1 or 2 medications, 27% (n = 17/62); 3 or more medications, 40% (n = 21/52); p = 0.03 (Armitage’s test for linear-trend in proportions). There was an association between increasing number of drops and decreasing emotional well-being scores (linear p < 0.001; quadratic p = 0.029). Black patients had higher dry eye symptoms and lower emotional QoL scores compared to white patients at every level of medication use. Conclusion An increasing number of glaucoma medications were associated with an increased frequency of severe dry eye symptoms and decreased emotional QoL. Additionally, dry eye specific emotional QoL was more severely affected in black versus white patients.

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“…Preservatives in glaucoma drops have been cited as the main culprit – studies have found that these preservatives decrease tear film stability and cause toxicity to the ocular surface epithelium in vitro and in vivo in both clinical and animal studies 8,9. As such, some propose the use of preservative-free IOP-lowering eye drops.…”

Section: Discussionmentioning

confidence: 99%

“…Topical ocular IOP-lowering drugs are believed to trigger or exacerbate OSD by inducing ocular surface damage, especially if they contain preservatives, such as benzalkonium chloride (BAK) 12. Preservatives in eye drops have been shown to be toxic to the ocular surface epithelium and decrease tear film stability 8,9. Topical glaucoma medications have also been associated with alterations in Meibomian gland function and morphology,3 tear film instability,10–13 decreased tear turnover and tear production,14–16 corneal anesthesia,17,18 corneal epithelial barrier dysfunction19,20 and inflammatory changes in the conjunctiva, ultimately resulting in OSD 21–24…”

Section: Introductionmentioning

confidence: 99%

Ocular lubricant use in medically and surgically treated glaucoma: a retrospective longitudinal analysis

Iyer

Zhao

Lim

et al. 2017

OPTH

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BackgroundChronic use of intraocular pressure-lowering medications is associated with ocular surface disease (OSD). In this study, we assess the incidence of topical lubricant use as a surrogate marker for underlying OSD, in medically and surgically treated glaucoma patients.MethodsRetrospective chart review was performed for newly diagnosed glaucoma patients who were started on topical medications in 2007 and followed up over a 5-year period. Primary outcome measure was the incidence of topical lubricant use in these patients and a subset of these patients who required glaucoma or cataract surgery during follow-up.ResultsCharts of 505 newly diagnosed glaucoma patients with no prior history of ocular lubricant use were analyzed. Mean age was 63.9 years (SD 11.1), 42.8% were women. One hundred one (20.0%) patients underwent phacoemulsification surgery, 80 underwent mitomycin C (MMC) augmented phacotrabeculectomy, 16 underwent MMC-augmented trabeculectomy and 3 underwent tube surgery during the course of follow-up as their only type of surgery. Five-year incidence of lubricant use was 59% in all glaucoma subjects; 54.1% of patients were on medical treatment and 74.0% of patients who underwent phacotrabeculectomy or trabeculectomy were started on lubricants, respectively (P=0.0011); 60.4% of glaucoma subjects who underwent phacoemulsification surgery were started on lubricants. Incidence of lubricant use increased from 17.7% preoperatively to 74.0% postoperatively in subjects who required trabeculectomy or phacotrabeculectomy. Incidence of lubricant use was similar in patients on one or multiple glaucoma medications, with the mean onset of lubricant use being 10 months after starting glaucoma medication in both groups. Females were more likely to use artificial tears compared with males (P=0.002).ConclusionBoth medical and surgical management of glaucoma have an adverse effect on the ocular surface. Chronic use of glaucoma medications was associated with a high incidence of ocular lubricant use. MMC-augmented trabeculectomy was associated with an even higher incidence of ocular lubricant use.

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Glaucoma therapy and ocular surface disease

Abstract: BAK-free and preservative-free therapies are becoming available but are not always a feasible alternative. It is important to recognize different clinical manifestations of allergy and chronic inflammation and to discuss options for patients experiencing OSD.

Cited by 93 publications

References 57 publications

Age-Related Changes of the Ocular Surface: A Hospital Setting-Based Retrospective Study

Age-Related Changes of the Ocular Surface: A Hospital Setting-Based Retrospective Study

Dry eye specific quality of life in veterans using glaucoma drops

Ocular lubricant use in medically and surgically treated glaucoma: a retrospective longitudinal analysis

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