Halting glaucoma progression can be challenging, but as it turns out, medication is not the only tool in an OD’s toolbox. Many factors influence glaucoma progression in patients, some of which may be unrelated to the disease itself.
ODs must be aware of the hidden links among glaucoma symptoms, medication, and contact lenses with respect to how ocular surface disease (OSD) affects patient outcomes.
Karen Lee, OD, FSLS, FAAO, and Jane Kuo, OD, FAAO, rose awareness to these links at the American Academy of Optometry 2019 meeting in Orlando.
Link Between OSD and Glaucoma
It is known that there is a higher prevalence of OSD in glaucoma patients, primarily related to decreased tear production and break up time. These symptoms may not be related to glaucoma proper, but instead, the medical drops patients use to manage symptoms.
In particular, the benzalkonium chloride (BAK) preservative is a common culprit, present in 70 percent of ophthalmic glaucoma drops. These drops may sometimes produce side effects in patients that may reduce treatment compliance.
“When you have patients with dry eye, it really decreases the quality of life. Anti-glaucoma eye drops containing BAK compromises patient compliance,” Dr. Kuo says.
This molecule disrupts the corneal epithelium by damaging DNA and increasing inflammation. Such a disruption can create particularly challenging concerns when the patient is a contact lens wearer.
Certain contact lenses, particularly hydrogel lenses with high water content, absorb BAK molecules and release them slowly into the corneal epithelium over time. Prolonged exposure to BAK is known to increase symptoms.
Fortunately, ODs can mitigate these corneal/drug interactions through patient education.
“The big idea here is that corneal exposure time to BAK tends to be relatively short-lived,” Dr. Lee says.
The U.S. Food & Drug Administration (FDA) recommends that patients using both glaucoma drops and contact lenses wait at least 15 minutes after instilling drops before applying their lenses. ODs should share this information with their patients to ensure they understand the possible interaction between their contact lenses and their medication.
Additionally, ODs who fit glaucoma patients in contact lenses can work these considerations into their lens selection.
“I might be reaching for a low water content hydrogel soft lens if I know the patient will abuse his drops with contact lens wear,” Dr. Lee says.