Ocular Surface Status in Newly Diagnosed Glaucoma Cases

Uncontrolled administration and prolonged use of antihypertensive drugs with preservatives often leads not only to subjectively poor tolerance of treatment, but also to a deterioration in the results of subsequent surgery, if required. The manifestations of dry eye syndrome and its aggravation as a result of such drops use can lead the patients to refuse therapy and worsening the prognosis. The manifestations of dry syndrome are often detected before any hypotensive therapy begins, since the functions of secretory cells change with age and there is always the influence of adverse environmental factors. It is necessary to examine the condition of the anterior surface of the eye to resolve the issue of the need to prescribe drugs without preservatives for all patients before the appointment of antihypertensive therapy. However, sometimes it is not possible due to lack of time or equipment. Therefore, it is important to study the condition of the anterior eye surface in patients with newly diagnosed glaucoma before and during treatment with nonpreservative forms of antihypertensive drugs in order to determine the necessity of the first prescription of non-preservative forms of antihypertensive drops to further interpolate its results into practical recommendations. This study revealed that drug treatment of patients with newly diagnosed glaucoma with the drug Timolol-POS® β-blocker on a non-preservative basis along with IOP compensation improves both subjective and objective indicators of the condition of the anterior surface of the eye with maximum effect after 3 months of treatment. This conclusion suggests the importance of the primary appointment for such patients with instillation drops on a preservative basis.

newly diagnosed glaucoma, intraocular pressure, Ocular Response Analyzer, eye surface, Schirmer test, Norn test, β-blocker, Timolol POS

1. European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition — Chapter 3: Treatment principles and options Supported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 3 Treatment principles and options. Br J Ophthalmol. 2017;101(6):130–195. DOI: 10.1136/bjophthalmol2016-EGSguideline.003

2. Pflugfelder S.C., Baudouin C. Challenges in the clinical measurement of ocular surface disease in glaucoma patients. Clin Ophthalmol. 2011;5:1575–1583. DOI: 10.2147/opth.s24410

3. Boimer C., Birt C.M. Preservative exposure and surgical outcomes in glaucoma patients: The PESO study. J Glaucoma. 2013;22:730–735. DOI: 10.1097/ IJG.0b013e31825af67d

4. Miki T., Naito T., Fujiwara M. Effects of pre-surgical administration of prostaglandin analogs on the outcome of trabeculectomy. PLoS One. 2017;12(7):e0181550. Published 2017 Jul 20. DOI: 10.1371/journal.pone.0181550

5. Kaštelan S., Tomić M., Metež Soldo K., Salopek-Rabatić J. How ocular surface disease impacts the glaucoma treatment outcome. Biomed Res Int. 2013;2013:696328. DOI: 10.1155/2013/696328

6. Broadway D.C., Grierson I., O’Brien C., Hitchings R.A. Adverse effects of topical antiglaucoma medication. II. The outcome of filtration surgery. Archives of Ophthalmology. 1994;112(11):1446–1454.

7. Thygesen J. Glaucoma therapy: preservative-free for all? Clin Ophthalmol. 2018;12:707–717. Published 2018 Apr 13. DOI: 10.2147/OPTH.S150816

8. Hirooka K., Nitta E., Ukegawa K., Tsujikawa A. Vision-related quality of life following glaucoma filtration surgery. BMC Ophthalmol. 2017;17(1):66. Published 2017 May 12. DOI: 10.1186/s12886-017-0466-7

9. Ji H., Zhu Y., Zhang Y., et al. The Effect of Dry Eye Disease on Scar Formation in Rabbit Glaucoma Filtration Surgery. Int J Mol Sci. 2017;18(6):1150. Published 2017 May 28. DOI: 10.3390/ijms18061150

10. King A.J., Fernie G., Azuara-Blanco A., et al. Treatment of Advanced Glaucoma Study: a multicentre randomised controlled trial comparing primary medical treatment with primary trabeculectomy for people with newly diagnosed advanced glaucoma-study protocol. Br J Ophthalmol. 2018;102(7):922–928. DOI: 10.1136/ bjophthalmol-2017-310902

11. Lee S.Y., Wong T.T., Chua J., Boo C., Soh Y.F., Tong L. Effect of chronic antiglaucoma medications and trabeculectomy on tear osmolarity. Eye (Lond). 2013;27(10):1142–1150. DOI: 10.1038/eye.2013.144

12. Allergan I. Accessed March 31, 2013; Ocular Surface Disease Index (OSDI). The Dry Eye Zone website, 1995. Available at: http://www.dryeyezone.com/encyclopedia/documents/OSDI.pdf

13. Burstein N.L. The effects of topical drugs and preservatives on the tears and corneal epithelium in dry eye. Trans Ophthalmol Soc U K. 1985;104( Pt 4):402–409. Review.

14. Zhu W., Kong X., Xu J., Sun X. Effects of Long-Term Antiglaucoma Eye Drops on Conjunctival Structures: An In Vivo Confocal Microscopy Study. J Ophthalmol. 2015;2015:165475. DOI: 10.1155/2015/165475

15. Herreras J.M., Pastor J.C., Calonge M., Asensio V.M. Ocular surface alteration after long-term treatment with an antiglaucomatous drug. Ophthalmology. 1992;99:1082–1088.

16. Pauly A., Brignole-Baudouin F., Labbe A., et al. New tools for the evaluation of toxic ocular surface changes in the rat. Invest. Ophthalmol. Vis. Sci. 2007;48:5473–5483.