Factors Affecting the Ocular Surface in Glaucoma Patients Using Preservative-Free Ocular Hypotensive Medications

Abstract

Purpose : Ocular surface disease (OSD) is common in glaucoma patients. Factors such as the number of eye drops and eye drops containing benzalkonium chloride or other preservatives may contribute to the presence of OSD. The coexistence of OSD and the use of preserved medications may impact vision-related quality of life in glaucoma patients. The objective of this study is to establish the prevalence of OSD in patients treated with preservative-free antiglaucoma medications, as well as define the risk factors for the development of OSD.

Methods : A retrospective analysis was conducted on 6,219 electronic medical records of patients evaluated for glaucoma at a specialized center in western Mexico.The evaluation of these records covered the period from November 17, 2017 to October 21, 2022. A total of 4,972 records that did not meet the required information were discarded, mainly because the presence of a preserved medication was identified as glaucoma treatment. The criteria for establishing the presence of ocular surface disease included OSDI scores, as well as clinical findings in the eyelids, cornea, and conjunctiva, regardless of symptoms. We analyzed the pattern of ocular hypotensive therapy and concurrent medications, as well as the health status of the patients. The type of glaucoma, its severity, and time of evolution were also considered. In the statistical analysis, a P value of less than 0.5 was considered statistically significant.

Results : Of the 1,247 electronic medical records included in the study, the majority were women (61.9%), with primary open-angle glaucoma (65.1%), under treatment for more than six months (70.9%). It was identified that the diagnosis of OSDI was present in 27.3% (n=340) of the evaluated patients. Of these, 16.5% (n=56), had severe OSDI. The following were the most significant risk factors for OSD: timolol (OR=1.91), age over 64 years (OR=1.28), use of more than two ocular hypotensive agents (OR=0.73), duration of glaucoma treatment longer than 8 months (OR=1.39), and use of more than one lubricant (OR=1.38).

Conclusions : Although the use of preservative-free ocular hypotensives seems to be related to a lower prevalence of OSD, other factors such as the duration of glaucoma treatment and the type of medication may be relevant to the presence of the disease.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.