Glaucoma therapy: preservative-free for all?

John Thygesen Department of Ophthalmology, Glaucoma Services in Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Abstract: Preservatives used in topical glaucoma medications have a plethora of well-described toxic effects on the ocular surface. Such ocular toxicity i...

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Autor principal:	Thygesen J
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Glaucoma topical therapy preservative toxicity preservative-free glaucoma medication ocular surface disease. Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/4938e6db002e40d3b07799efc9a43113
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spelling	oai:doaj.org-article:4938e6db002e40d3b07799efc9a431132021-12-02T05:52:51ZGlaucoma therapy: preservative-free for all?1177-5483https://doaj.org/article/4938e6db002e40d3b07799efc9a431132018-04-01T00:00:00Zhttps://www.dovepress.com/glaucoma-therapy-preservative-free-for-all-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483John Thygesen Department of Ophthalmology, Glaucoma Services in Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Abstract: Preservatives used in topical glaucoma medications have a plethora of well-described toxic effects on the ocular surface. Such ocular toxicity is manifest clinically as ocular surface disease (OSD) and has been confirmed in epidemiologic, prospective clinical trials and studies in which patients are switched from preservative-added to preservative-free topical therapy. Such toxicity has implications not only for tolerability, but also for adherence and persistence with therapy that is known to be poor in glaucoma. Glaucoma medication is now widely available in preservative-free formulations, and the question arises as to which patients should receive preservative-free glaucoma therapy in preference to preservative-added medication. A case can be made for several subpopulations of patients who might particularly benefit from preservative-free medication: patients with existing OSD, older patients, younger adult patients, female patients, pediatric and juvenile patients, patients who work in air-conditioned environments or who use electronic screens frequently, patients with medical risk factors for OSD, patients in whom trabecular surgery may become indicated in the future, contact lens users, perhaps patients with Asian ethnicity and patients with severe or treatment-refractory glaucoma. Whilst arguments could be made for selecting patients for preservative-free medication on the basis of their existing risk of OSD, collectively, these patients form a significant proportion of the glaucoma patient population as a whole and, in the absence of any cost premium or positive indication for preservative-added medication, preservative-free glaucoma medication for all patients seems an appropriate strategy. Keywords: glaucoma, topical therapy, preservative toxicity, preservative-free glaucoma medication, ocular surface diseaseThygesen JDove Medical PressarticleGlaucomatopical therapypreservative toxicitypreservative-free glaucoma medicationocular surface disease.OphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 12, Pp 707-717 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Glaucoma topical therapy preservative toxicity preservative-free glaucoma medication ocular surface disease. Ophthalmology RE1-994
spellingShingle	Glaucoma topical therapy preservative toxicity preservative-free glaucoma medication ocular surface disease. Ophthalmology RE1-994 Thygesen J Glaucoma therapy: preservative-free for all?
description	John Thygesen Department of Ophthalmology, Glaucoma Services in Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Abstract: Preservatives used in topical glaucoma medications have a plethora of well-described toxic effects on the ocular surface. Such ocular toxicity is manifest clinically as ocular surface disease (OSD) and has been confirmed in epidemiologic, prospective clinical trials and studies in which patients are switched from preservative-added to preservative-free topical therapy. Such toxicity has implications not only for tolerability, but also for adherence and persistence with therapy that is known to be poor in glaucoma. Glaucoma medication is now widely available in preservative-free formulations, and the question arises as to which patients should receive preservative-free glaucoma therapy in preference to preservative-added medication. A case can be made for several subpopulations of patients who might particularly benefit from preservative-free medication: patients with existing OSD, older patients, younger adult patients, female patients, pediatric and juvenile patients, patients who work in air-conditioned environments or who use electronic screens frequently, patients with medical risk factors for OSD, patients in whom trabecular surgery may become indicated in the future, contact lens users, perhaps patients with Asian ethnicity and patients with severe or treatment-refractory glaucoma. Whilst arguments could be made for selecting patients for preservative-free medication on the basis of their existing risk of OSD, collectively, these patients form a significant proportion of the glaucoma patient population as a whole and, in the absence of any cost premium or positive indication for preservative-added medication, preservative-free glaucoma medication for all patients seems an appropriate strategy. Keywords: glaucoma, topical therapy, preservative toxicity, preservative-free glaucoma medication, ocular surface disease
format	article
author	Thygesen J
author_facet	Thygesen J
author_sort	Thygesen J
title	Glaucoma therapy: preservative-free for all?
title_short	Glaucoma therapy: preservative-free for all?
title_full	Glaucoma therapy: preservative-free for all?
title_fullStr	Glaucoma therapy: preservative-free for all?
title_full_unstemmed	Glaucoma therapy: preservative-free for all?
title_sort	glaucoma therapy: preservative-free for all?
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/4938e6db002e40d3b07799efc9a43113
work_keys_str_mv	AT thygesenj glaucomatherapypreservativefreeforall
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Glaucoma therapy: preservative-free for all?

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