Marguerite McDonald, MD, FACS: The dry eye patient who’s on a glaucoma medication, Rich, you touched on it before. There are quite a few peer-reviewed publications indicating that that leads to noncompliance and loss of visual field, etcetera, because of the terrible discomfort of putting a glaucoma drop on a dry eye.
Richard Mangan, OD, FAAO: Yes, and I see that unfortunately a lot as well. And I hear arguments on both ends, that lowered cost should lead to greater compliance. At the same time, if it’s a product that’s not beneficial to the ocular surface, they oftentimes won’t use it and sometimes stop more than just 1 offending agent. They’re not sure which 1 it is.
Marguerite McDonald, MD, FACS: Stop them all.
Richard Mangan, OD, FAAO: They’re less compliant with all of them, and again, that’s where patient education is very important about if there’s any concern about how a drop is feeling on the eye, that they need to let us know.
Marguerite McDonald, MD, FACS: Does that lead you more toward non-preserved unit dose BAK [benzalkonium chloride]-free medicines?
Eric Donnenfeld, MD, FACS: Of course you want to minimize the number of drops the patient receives, so a once-a-day glaucoma drop is better than a twice-a-day glaucoma drop, which is of course better than a three-times-a-day glaucoma drop. Limit the BAK. For patients who have significant dry eye problems, you can start them on non-preserved drops. But very commonly when I have a patient who has dry eye to start with and we’re starting glaucoma therapy, I think it’s really a good idea to manage their dry eye at the same time that you manage their glaucoma. Putting patients on immunosuppressive therapies concomitantly with glaucoma management I think does a great job in assuring patient satisfaction and making sure the medications stay where you want them to go. The use of lifitegrast or cyclosporine I think are really important for our glaucoma colleagues to use to make certain our patients get the right outcome.