Ocular lubricant use in medically and surgically treated glaucoma: a retrospective longitudinal analysis

Abstract

BackgroundChronic use of intraocular pressure-lowering medications is associated with ocular surface disease (OSD). In this study, we assess the incidence of topical lubricant use as a surrogate marker for underlying OSD, in medically and surgically treated glaucoma patients.MethodsRetrospective chart review was performed for newly diagnosed glaucoma patients who were started on topical medications in 2007 and followed up over a 5-year period. Primary outcome measure was the incidence of topical lubricant use in these patients and a subset of these patients who required glaucoma or cataract surgery during follow-up.ResultsCharts of 505 newly diagnosed glaucoma patients with no prior history of ocular lubricant use were analyzed. Mean age was 63.9 years (SD 11.1), 42.8% were women. One hundred one (20.0%) patients underwent phacoemulsification surgery, 80 underwent mitomycin C (MMC) augmented phacotrabeculectomy, 16 underwent MMC-augmented trabeculectomy and 3 underwent tube surgery during the course of follow-up as their only type of surgery. Five-year incidence of lubricant use was 59% in all glaucoma subjects; 54.1% of patients were on medical treatment and 74.0% of patients who underwent phacotrabeculectomy or trabeculectomy were started on lubricants, respectively (P=0.0011); 60.4% of glaucoma subjects who underwent phacoemulsification surgery were started on lubricants. Incidence of lubricant use increased from 17.7% preoperatively to 74.0% postoperatively in subjects who required trabeculectomy or phacotrabeculectomy. Incidence of lubricant use was similar in patients on one or multiple glaucoma medications, with the mean onset of lubricant use being 10 months after starting glaucoma medication in both groups. Females were more likely to use artificial tears compared with males (P=0.002).ConclusionBoth medical and surgical management of glaucoma have an adverse effect on the ocular surface. Chronic use of glaucoma medications was associated with a high incidence of ocular lubricant use. MMC-augmented trabeculectomy was associated with an even higher incidence of ocular lubricant use.

Glaucoma and Ocular Surface Disease: More than Meets the Eye

“…One 5-year retrospective study of 500 patients with glaucoma showed that 54% used artificial tears. 69 One randomized double-masked, controlled study compared two types of preservative-free artificial tears: sodium hyaluronate and hydroxypropyl methylcellulose (HPMC)/dextran. 70 HPMC is a conventional ingredient of artificial tears, while sodium hyaluronate is a naturally lubricating viscoelastic solution that has demonstrated a reduction in the ocular toxicity of BAK with in vitro studies.…”

Cross-Linked Hyaluronic Acid as Tear Film Substitute

“…[60][61][62] It has been largely demonstrated that the number of glaucoma patients suffering from dry eye increases with the number of medications used and with disease duration. 63 In this particular population, the use of preservative-free medications and tear supple-ment [64][65][66][67] is very useful to reduce dry eye symptoms. Particularly, cross-linked HA, for its stability and persistence over the ocular surface, may represent a valid alternative.…”

The Results of Transscleral Diode Laser Cyclophotocoagulation in Micropulse Mode Treatment in Patients with Primary Subcompensated Open-Angle Glaucoma and Toxic-Allergic Syndrome of the Ocular Surface

“…При этом каждая дополнительная капля гипотензивного средства статистически достоверно (примерно на четверть) повышает так называемый индекс патологии глазной поверхности (Ocular Surface Disease Index, OSDI). Особенно страдают пациенты с фоновым синдромом сухого глаза [3,4].…”