Many studies have proven the widespread noncompliance issues glaucoma patients face. The more patients are asked to do, particularly if they are elderly, infirm or already juggling multiple medications, the less likely they are to fully comply. It is an extreme burden. Added to this burden are the effects of dry eye disease that are often a byproduct of glaucoma medications. Those containing preservatives especially may cause or exacerbate existing dry eye. Adding more drops will only further disrupt the tear surface. Many patients, especially older women, are already experiencing dry eye symptoms due to the hormonal changes that accompany menopause, making this problem even worse. As a doctor in a dry eye clinic, I always do whatever possible to minimize further exacerbation of dry eye problems.
To that end, I first try selective laser trabeculoplasty or MicroPulse laser trabeculoplasty (Iridex), especially if the patient is on several medications or is at greater risk because of advanced glaucoma disease. Laser treatments not only spare the patient from adding additional drops to their regimen, they minimize the danger of creating or worsening a dry eye problem. Additionally, these treatments often have the greatly beneficial result of reducing the number of medications needed.
These treatments are covered by insurance. Effects last anywhere from 1 to 4 years, with an average of 2 years. Effects are repeatable, meaning that unlike with argon laser trabeculoplasty, these treatments produce a consistent IOP each time they are employed. Treatments can be repeated individually as often as needed by the patient.
Being able to provide these treatments in the convenience and comfort of the clinic is of great benefit to both doctors and patients. But the true benefit comes in the ability to reduce or eliminate medications that cause patients such aggravation. People are busy. Anything we can do to address their medical concerns and simplify their life is worth it.
Disclosure: Toyos reports she is a speaker and consultant for Valeant and Sun; conducts research for Lumenis, Magellan and Kala; is a speaker and consultant and does research for Shire, Mallinckrodt and MixtoLasering; is a consultant and does research for DigiSight; does research for Novaliq; and is a consultant for Iridex.