Preeya K. Gupta
KOLOA, Hawaii — The ocular surface should not be forgotten when managing patients with glaucoma, according to a presenter at Hawaiian Eye 2020.
“Glaucoma management causes dry eye and ocular surface disease,” Preeya K. Gupta, MD, said.
Evidence shows that ocular surface disease is present in up to 59% of patients with glaucoma using drops, according to Gupta.
“That means it is more likely that the patient in your chair will have coincident ocular surface disease than not,” she said.
Topical medications for glaucoma can be toxic and inflammatory, and surgery can disrupt the tear duct and thus, dry eye, she said.
“Ocular surface disease has a real impact on not only glaucoma management but how our patients see and their perception of the quality of their vision,” Gupta said.
The prevalence and severity of ocular surface disease is associated with how often drops are used, as well as BAK exposure. The odds of developing ocular surface disease double with each additional BAK-containing eye drop. While more drops benefit glaucoma and pressure management, they can negatively impact the surface of the eye, Gupta said.
“It isn’t necessarily one medication,” she said.
Prostaglandins commonly cause meibomian gland dysfunction, alpha-adrenergic agonists increase the rate of ocular allergies, carbonic anhydrase inhibitors increase corneal thickness and beta-blockers can reduce basal tear turnover rate, according to Gupta.
“It doesn’t matter which medication you are using, they all have potential negative effects,” she said.
However, modern therapies are improving, she said.
“We have had advancements with preservative-free glaucoma medications and non-medication therapies like selective laser trabeculoplasty,” Gupta said.
Studies demonstrate that those procedures can lower pressure and wean patients off medications. Additionally, MIGS has helped to reduce medication burden, she said.
“But, I think the future is going to be sustained drug delivery — things that take some of the compliance issues out, but also help to preserve the ocular surface,” Gupta said. – by Alaina Tedesco
Reference: Gupta PK. Corneal considerations in glaucoma. Presented at: Hawaiian Eye 2020; Jan. 18-24, 2020; Koloa, Hawaii.
Disclosure: Name reports being a consultant for Alcon, Allergan, Aurea, Bausch + Lomb, Dompé, EyePoint Pharmaceuticals, Johnson & Johnson Vision, Kala, New World Medical, NovaBay Pharmaceuticals, Novartis, Ocular Science, Oyster Point Pharmaceuticals, TearLab and Zeiss.