• Therapeutic Cataract & Refractive
  • Lens Technology
  • Glasses
  • Ptosis
  • Comprehensive Eye Exams
  • AMD
  • COVID-19
  • DME
  • Ocular Surface Disease
  • Optic Relief
  • Geographic Atrophy
  • Cornea
  • Conjunctivitis
  • Myopia
  • Presbyopia
  • Allergy
  • Nutrition
  • Pediatrics
  • Retina
  • Cataract
  • Contact Lenses
  • Lid and Lash
  • Dry Eye
  • Glaucoma
  • Refractive Surgery
  • Comanagement
  • Blepharitis
  • OCT
  • Patient Care
  • Diabetic Eye Disease
  • Technology

Glaucoma lecturer likens preserved drops to processed foods-neither is the healthiest ideal



San Diego-“Trying to reduce BAK load is the right thing to do overall,” said Michael Chaglasian, OD, associate professor at Illinois College of Optometry and chief of staff at the Illinois Eye Institute. In his lecture yesterday morning, Preservative vs. Preservative Free Medication in Glaucoma, Dr. Chaglasian made a strong case that there are several deleterious effects of BAK, which should prompt practitioners to avoid them in many cases.

Dr. Chaglasian admitted he wasn’t always concerned about BAK. In fact, he said he didn’t used to pay much attention to ocular surface disease in his glaucoma patients. But, the Dry Eye Work Shop (DEWS) report in 2007 was a wake-up moment for him. The DEWS conclusion that the elimination of preservatives from OTC lubricants was a huge leap forward in ocular surface care made him think more seriously about the effects of preservatives in the glaucoma meds he prescribed. He wondered, “If preservatives play such a big role in ocular surface health, how might they be affecting my glaucoma patients, who use them long term?”

Since effects of preserved drops in glaucoma treatment tend to be subtle and build up over time, they are often overlooked. “But they can have a significant impact,” he said. BAK has several effects on the ocular surface, including:

  • Decreased epithelial cell integrity

  • Increased conjunctival inflammatory cells

  • Loss of goblet cells

  • Reduced tear function

  • Reduced TBUT

Beyond it’s relationship to ocular surface disease, BAK is associated with filtration bleb failure in trabeculectomy patients and inflammatory cell infiltration in the trabecular meshwork. Furthermore, new research also suggests that BAK affects the eyelid muscles, causing incomplete blink and lagophthalmus in animal models.

Dr. Chaglasian recommended that doctors consider the following factors when prescribing topical medications as these contribute to preservative toxicity:

  • Concentration

  • Frequency and duration of use

  • Tear production and clearance

  • Contact lens use

  • Number and type of concurrent meds

  • Type of preservative

Not every patient needs to be treated with BAK-free drops but, he said, clinicians need an evaluation and workup to avoid harming at-risk patients.ODT

Related Videos
Raman Bhakhri, OD, FAAO, overviews his talk on medications' potential side effects on the retina with Optometry Times
Jacobi Cleaver, OD, FAAO
Jade Coats, OD, overviews a lecture on ocular pain and patient care
Jade Coats, OD, outlines two poster presentations she gave on a novel lipid-containing eye drop at the AOA Optometry's Meeting
Adam Alexander, OD, chats with Optometry Times about his AOA e-poster presentation on Miebo
Lorraine Provencher, MD, presenting slides
Megan Cavet, PhD
Nazlee Zebardast, MD, MSc, overviews her ARVO 2024 presentations on glaucoma and polygenic risk scores
© 2024 MJH Life Sciences

All rights reserved.