Perspectives on Glaucoma

Patients on glaucoma drugs have significant meibomian gland dropout

Patients treated with anti-glaucoma medications have significant meibomian gland dropout, and the effect is proportional to the number of medications and instillations per day, according to a study.

Thirty healthy eyes of 30 subjects and 85 eyes of 85 subjects with glaucoma under different dosages and instillation regimens of IOP-lowering medications were included.

For each eye, slit lamp examination, tear break-up time, lipid interferometry, blinking video recording, Schirmer’s test and meibography were performed. All subjects completed the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, designed to assess the frequency and severity of dry eye symptoms in meibomian gland dysfunction. For each glaucoma patient, the burden of anti-glaucoma regimen (BAG) score was determined in relation to the type, number, instillation times per day and total monthly instillations of IOP-lowering medications.

Patients with glaucoma were found to have significantly lower SPEED scores than healthy participants, and a significant correlation between BAG score and meibomian gland loss was found. The higher burden group had significantly more severe meibomian gland dropout, lower meibomian gland density and meibomian gland loss ratio, while meibum quality, meibomian gland expressibility and meibomian gland secretion did not significantly differ between groups.

“This scoring system can be easily applied in the clinical practice to monitor the cumulative anti-glaucoma burden during follow-up and helps physicians consider meibomian gland and ocular surface disease as a possible sequelae of topical treatment,” the authors wrote.

They also pointed out that further studies are needed to clarify whether the cumulative dosage effect is induced by the active ingredients of glaucoma medications or by the preservatives. – by Michela Cimberle

Disclosure: The authors reported no conflict of interest

Patients treated with anti-glaucoma medications have significant meibomian gland dropout, and the effect is proportional to the number of medications and instillations per day, according to a study.

Thirty healthy eyes of 30 subjects and 85 eyes of 85 subjects with glaucoma under different dosages and instillation regimens of IOP-lowering medications were included.

For each eye, slit lamp examination, tear break-up time, lipid interferometry, blinking video recording, Schirmer’s test and meibography were performed. All subjects completed the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, designed to assess the frequency and severity of dry eye symptoms in meibomian gland dysfunction. For each glaucoma patient, the burden of anti-glaucoma regimen (BAG) score was determined in relation to the type, number, instillation times per day and total monthly instillations of IOP-lowering medications.

Patients with glaucoma were found to have significantly lower SPEED scores than healthy participants, and a significant correlation between BAG score and meibomian gland loss was found. The higher burden group had significantly more severe meibomian gland dropout, lower meibomian gland density and meibomian gland loss ratio, while meibum quality, meibomian gland expressibility and meibomian gland secretion did not significantly differ between groups.

“This scoring system can be easily applied in the clinical practice to monitor the cumulative anti-glaucoma burden during follow-up and helps physicians consider meibomian gland and ocular surface disease as a possible sequelae of topical treatment,” the authors wrote.

They also pointed out that further studies are needed to clarify whether the cumulative dosage effect is induced by the active ingredients of glaucoma medications or by the preservatives. – by Michela Cimberle

Disclosure: The authors reported no conflict of interest

    Perspective
    Carl H. Jacobsen

    Carl H. Jacobsen

    We know quite a bit about ocular surface disease and glaucoma. Meibomian gland dysfunction is exacerbated by topical medications. Preservatives, primarily BAK, also served to disrupt the ocular surface, and prostaglandin analogues appear to be worse than other medications. Finally, taking multiple medications has an even more profound impact.

    Cho and colleagues have devised a simple scoring system to monitor the cumulative burden that ocular medications place on the eye. So, am I going to have each glaucoma patient complete a SPEED survey and then calculate their BAG score? On every visit? Not a chance.

    While such systems might be helpful in a research environment, in clinic there just isn’t enough time or enough benefit to justify administering surveys and calculating scores. I do think we should understand how glaucoma treatment affects the ocular surface.

    Talk to your patients. Ask them how they are feeling, listen carefully and do a careful assessment of the ocular surface. Offer treatment options such as nonpreserved or minimally preserved preparations when they are uncomfortable and slit lamp evidence suggests a need. Be a doctor and offer personal care. Your patients will love you, and their glaucoma will be better controlled.

    • Carl H. Jacobsen, OD, FAAO
    • University of California Berkeley, School of Optometry

    Disclosures: Jacobsen is on the Alcon speakers bureau and has been an advisor to Sucampo.