Glaucoma therapy: preservative-free for all?

Abstract

Preservatives used in topical glaucoma medications have a plethora of well-described toxic effects on the ocular surface. Such ocular toxicity is manifest clinically as ocular surface disease (OSD) and has been confirmed in epidemiologic, prospective clinical trials and studies in which patients are switched from preservative-added to preservative-free topical therapy. Such toxicity has implications not only for tolerability, but also for adherence and persistence with therapy that is known to be poor in glaucoma. Glaucoma medication is now widely available in preservative-free formulations, and the question arises as to which patients should receive preservative-free glaucoma therapy in preference to preservative-added medication. A case can be made for several subpopulations of patients who might particularly benefit from preservative-free medication: patients with existing OSD, older patients, younger adult patients, female patients, pediatric and juvenile patients, patients who work in air-conditioned environments or who use electronic screens frequently, patients with medical risk factors for OSD, patients in whom trabecular surgery may become indicated in the future, contact lens users, perhaps patients with Asian ethnicity and patients with severe or treatment-refractory glaucoma. Whilst arguments could be made for selecting patients for preservative-free medication on the basis of their existing risk of OSD, collectively, these patients form a significant proportion of the glaucoma patient population as a whole and, in the absence of any cost premium or positive indication for preservative-added medication, preservative-free glaucoma medication for all patients seems an appropriate strategy.

Better tolerance of preservative-free latanoprost compared to preserved glaucoma eye drops: the 12-month real-life FREE study

“…Furthermore, it appreciating the fact that a prolonged use of preserved glaucoma eye drops causes OSDs as well as other ocular signs and symptoms while they do not provide any better clinical efficacy than PF latanoprost eye drops, thus supporting the clinical relevance of the findings in this study. 26 …”

Influence of new treatment modalities on adherence in glaucoma

“…In addition, a consensus on how to define success is needed. ocular surface [19]. Kim [20] showed that glaucoma patient using topical medications had a higher incidence of Meibomian gland disease than controls.…”

Influence of treatment adherence on the progression of primary open-angle glaucoma in clinical setting

“…Ряд авторов указывают на существенное повышение приверженности у пациентов, получающих бесконсервантную терапию. Бесконсервантные препараты ни в чем не уступают консервантным формам, а с позиций качества жизни, приверженности к лечению, улучшения прогноза последующего хирургического лечения превосходят их для всех категорий пациентов [15]. Тем не менее доля бесконсервантных препаратов в терапии глаукомы по-прежнему остается небольшой.…”