OSD in glaucoma patients

Cheryl Guttman Krader

Posted: Saturday, September 22, 2018

GLAUCOMA is not just an optic neuropathy – it is also an ocular surface disease (OSD), said Florent Aptel MD, PhD.
Speaking at the 9th EuCornea Congress, Dr Aptel discussed OSD prevalence among patients with glaucoma and reviewed the etiology, diagnosis and management of OSD.
Results of several studies document that OSD is very common in glaucoma patients and show that it is related to the burden of use of medications containing preservatives. For example, one study found that more than half of glaucoma patients using two or three medications containing preservatives had signs or symptoms of OSD.
Findings from epidemiologic studies and basic science research establish benzalkonium chloride (BAK) as the primary culprit in medication-related OSD toxicity.
“Therefore, it is likely better to avoid glaucoma medications preserved with BAK, especially in patients with OSD as well as in patients who are on multidrug regimens or who will have future filtering surgery,” said Dr Aptel, professor of ophthalmology, University Hospital of Grenoble, Grenoble, France.
“Fortunately, there are several preservative-free glaucoma medications available now in both monotherapy and fixed combination options. Results of comparative studies show no differences in the IOP-lowering activity of preservative-containing and preservative-free formulations of the same active ingredient.”
Identifying the presence of OSD in patients with glaucoma should begin with a good history.
“It is very important to remember that in most patients, the symptoms of OSD precede the physical abnormalities,” Dr Aptel said.
Slit-lamp examination and fluorescein staining are generally adequate to assess for signs of OSD.