Impact of glaucoma medications on the ocular surface and how ocular surface disease can influence glaucoma treatment

Kolko, Miriam; Gazzard, Gus; Baudouin, Christophe; Beier, Sofie; Brignole-Baudouin, Françoise; Cvenkel, Barbara; Fineide, Fredrik; Hedengran, Anne; Hommer, Anton; Jespersen, Erik; Messmer, Elisabeth M.; Murthy, Rachna; Sullivan, Amy Gallant; Tatham, Andrew J.; Utheim, Tor Paaske; Vittrup, Marijke; Sullivan, David A.

doi:10.1016/j.jtos.2023.05.012

Cited by 7 publications

(8 citation statements)

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“…Since intraocular pressure (IOP) is the sole modifiable risk factor for the disease, IOP-lowering strategies remain the mainstay of treatment [ 1 ]. While IOP reduction has been effectively achieved by IOP-lowering medication, long-term use raises concerns about adherence issues, side effects, and the potential impact on ocular surface changes affecting future surgical outcomes [ 2 ]. Selective laser trabeculoplasty (SLT) has recently emerged as a safe and cost-effective alternative to medications.…”

Section: Introductionmentioning

confidence: 99%

Identifying Baseline Predictors of Selective Laser Trabeculoplasty Effectiveness: An Alternative Mathematical Approach

Dendumrongsup

2024

Cureus

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Background: Selective laser trabeculoplasty (SLT) emerges as a first-line treatment for newly diagnosed open-angle glaucoma and ocular hypertension. However, the interindividual response to SLT considerably varied. Large-scale clinical investigations concerning predictive factors for SLT effectiveness are limited. This study aimed to identify baseline predictors of the percentage intraocular pressure (IOP)-lowering effectiveness of SLT using an alternative mathematical approach. Methods: Mathematical equations of IOP under the steady state of aqueous humour flow were formulated. The conclusive equation integrates physiological variables, including trabecular outflow facility, uveoscleral outflow fraction, plasma protein concentration, albumin/globulin ratio, mean arterial pressure, episcleral venous pressure, and plasma osmolarity. The equation was employed to estimate the percentage of IOP reduction following SLT and subsequently subjected to global sensitivity analysis to determine significant predictors of the IOP-lowering effect of SLT using the Monte Carlo simulation of 8,192 samples. Results: In the current model, a 50% improvement in the trabecular outflow facility impacted by SLT is associated with a mean percentage IOP reduction of 16.6%. Lower baseline trabecular outflow facilities were the strongest predictors, showing a correlation with greater effectiveness of SLT in terms of percentage of IOP reduction. The second most influential factor includes baseline uveoscleral outflow fraction, followed by baseline episcleral venous pressure. Specifically, lower baseline uveoscleral outflow fraction and episcleral venous pressure were found to be correlated with increased effectiveness of SLT. Baseline levels of plasma protein concentration, albumin/globulin ratio, mean arterial pressure, and plasma osmolarity have minimal impact on SLT success or failure. Conclusion: This study identifies baseline trabecular outflow facilities as the strongest predictor of SLT effectiveness. The results suggested that pre-SLT medical treatment that augments uveoscleral outflow and/or trabecular outflow facilities could compromise the effectiveness of subsequent SLT in terms of percentage IOP reduction compared to those who never received pre-SLT medication.

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Section: Introductionmentioning

confidence: 99%

Identifying Baseline Predictors of Selective Laser Trabeculoplasty Effectiveness: An Alternative Mathematical Approach

Dendumrongsup

2024

Cureus

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“…In vivo confocal microscopy showed that squamous metaplasia, inflammatory cell infiltrates (granulocytes, lymphocytes, Langerhans cells), dendritic cell activation, loss of goblet cells and stromal fibrosis are the most often seen changes in the conjunctival and corneal epithelium 5 . Therefore, the role of the ocular surface has become prominent, influencing the tolerability of glaucoma treatment 6,7 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of ocular surface following PreserFlo Microshunt implantation: Functional outcomes and quality of life

Gambini,

Carlà,

Giannuzzi

et al. 2023

Clinical Exper Ophthalmology

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BackgroundThis study aimed to evaluate the impact of PreserFlo Microshunt on the ocular surface, focusing on both objective and subjective parameters.MethodsProspective‐observational study on 48 eyes undergoing PreserFlo Microshunt implantation, standalone or combined with phacoemulsification. At baseline, 1‐month, 6‐months and 12‐months post‐operative follow‐ups, we performed Ocular Surface Disease Index (OSDI) questionnaire, Schirmer's test (ST), Tear‐film break‐up time (TBUT), fluoresceine staining (FS), tear osmolarity and minimum corneal epithelial thickness (Epi‐ThkMIN.) measurements.ResultsOSDI score improved from 37.43 ± 17.49 at baseline, to 24.13 ± 12.55 at 1‐month (p = 0.003) and to 12.89 ± 8.54 and 13.09 ± 10.22 at 6‐months and 12‐months (p < 0.0001). TBUT and ST, in a similar way, non‐significantly increased at 1‐month, but then improved at 6‐months and 12‐months (p < 0.05 for both). Tear osmolarity significantly decreased from 308.2 ± 7.3 mOsm/L at baseline, to 303.3 ± 8.2 mOsm/L, 295.6.2 ± 7.0 mOsm/L and 297.6 ± 6.8 mOsm/L at 1‐month, 6‐months and 12‐months (p < 0.05 for all). Epi‐ThkMIN was stable when comparing baseline (44.9 ± 5.7 μm) and 1‐month (p = 0.28), and successively increased in 6‐months (47.8 ± 5.5 μm, p = 0.02) and 12‐months (48.0 ± 3.6 μm, p = 0.01). In subgroup analysis, OSDI score and tear osmolarity were significantly higher at 1‐month in combined group compared to standalone group (p = 0.03 and p = 0.02, respectively), but reaching comparable values in successive follow‐ups. Further, Oxford scale grades for FS were significantly improved when comparing baseline–6‐months and baseline–12‐months.ConclusionPreserFlo implantation improved ocular surface subjective symptoms, increased TBUT and ST, and reduced FS, highlighting the potential benefits of this surgical intervention. Moreover, we reported significant improvements of tear osmolarity and corneal epithelium.

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“…[ 10 11 12 ] The reported adverse effects of topical glaucoma medications include worsening of DED, drug-induced dermato-conjunctivitis, follicular conjunctivitis, allergic contact dermatitis, impairment of corneal wound healing, corneal limbal stem cell deficiency, and also severe reactions such as pseudo-pemphigoid and mucous membrane pemphigoid. [ 13 ] The most commonly used anti-glaucoma medications, timolol and latanoprost, on long-term instillation result in chronic ocular surface disease with timolol-induced corneal punctate erosions, burning sensation, hyperemia, tear film alterations, and corneal anesthesia. Topical latanoprost therapy results in increased pigmentation of the iris, hypertrichosis, hyperemia, allergic contact dermatitis, and cystoid macular edema.…”

mentioning

confidence: 99%

“…The influence of the active ingredients in glaucoma medications on all the components of the ocular surface including the nasolacrimal duct and periorbital area have also been elaborately reported in the literature. [ 13 ] Long-term anti-glaucoma therapy-induced dry eye has been observed to be associated with decreased corneal sub-basal nerve fiber layer density. [ 14 ] BAK preservative in anti-glaucoma medications promotes the activation of lipooxygenases, synthesis and secretion of eicosanoids, inflammatory mediators, and many cytokines such as interleukin (IL)-1a, tumor necrosis factor, IL-8, and IL-10, which cause irritation, delayed hypersensitivity, and allergic reactions.…”

mentioning

confidence: 99%

“…[ 15 ] Besides long-term anti-glaucoma therapy affecting the ocular surface due to the adverse influence of the ocular hypotensive drug ingredients and BAK preservatives, glaucoma filtering surgeries, adjunct procedures such as bleb needling, and anti-metabolite treatments used during the surgical procedures also have an adverse influence through direct toxic effects to the ocular surface epithelium and the limbal stem cells, meibomian glands or goblet cell damage, interference with the optimal tear resurfacing, and predisposition to ocular surface infections. [ 13 16 17 ] Newer anti-glaucoma medications such as netarsudil also affect the ocular surface with reticular macrocellular corneal edema. [ 18 ] Significant ocular surface disease in patients with glaucoma results in poorer quality of life and patient compliance to treatment adherence, worsening the vision-related quality of life in these patients.…”

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confidence: 99%

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Glaucoma and ocular surface

Vanathi

2024

Indian Journal of Ophthalmology

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Impact of glaucoma medications on the ocular surface and how ocular surface disease can influence glaucoma treatment

Cited by 7 publications

References 175 publications

Identifying Baseline Predictors of Selective Laser Trabeculoplasty Effectiveness: An Alternative Mathematical Approach

Identifying Baseline Predictors of Selective Laser Trabeculoplasty Effectiveness: An Alternative Mathematical Approach

Evaluation of ocular surface following PreserFlo Microshunt implantation: Functional outcomes and quality of life

Glaucoma and ocular surface

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