Treatment of Glaucoma: Without Preservatives for Everyone?
A comprehensive report by Professor John Thygesen from the University Hospital in Copenhagen analyzes patient groups for whom preservative-free antiglaucoma medications are particularly suitable. In conclusion, he suggests that if there are no price differences, widespread treatment with preservative-free preparations is preferable.
Toxicity of Preservatives and Its Consequences
Preservatives used in the local treatment of glaucoma have a number of well-described toxic effects, which clinically manifest as ocular surface disease, as confirmed in epidemiological clinical studies and further in studies where patients switched from local therapy to preservative-free treatment. This toxicity impacts not only tolerance but also adherence to therapy, which tends to be generally low in glaucoma. Moreover, evidence is growing that accompanying inflammation may negatively affect the outcomes of antiglaucoma surgeries.
Who Should Especially Prefer Preservative-Free Treatment?
Antiglaucoma medications are now widely available in preservative-free formulations, so the question arises as to which patients should be prioritized for preservative-free treatment. Numerous subgroups can be identified that have an increased risk of ocular surface disease or for whom its occurrence would be particularly undesirable.
The following groups could benefit from preservative-free treatment, among others: patients with pre-existing ocular surface disease, elderly individuals, people working in air-conditioned environments, those who frequently use electronic screens, patients with risk factors for developing ocular surface disease, those considering trabeculectomy in the future, contact lens wearers, possibly patients of Asian origin, and last but not least, patients with severe glaucoma unresponsive to treatment.
Conclusion
While arguments can be made for selecting patients suitable for preservative-free treatment based on their existing risk of ocular surface disease, it is clear that these individuals constitute a significant portion of the overall glaucoma patient population. Therefore, if there are no financial differences or positive indications for treatment with preservative-containing medications, preservative-free antiglaucoma therapy appears to be a suitable strategy for all patients.
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Source: Thygesen J. Glaucoma therapy: preservative-free for all? Clin Ophthalmol 2018; 12: 707−717, doi: 10.2147/OPTH.S150816.
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