SLT Reduces Glaucoma Treatment Side Effects in Patients with OSD
By Jason Bacharach, MD
Ocular surface disease (OSD) often coexists with other eye conditions, especially glaucoma. In fact, approximately 60% of glaucoma patients show some signs of OSD.1 This is not surprising considering the demographic overlay — both diseases increase in prevalence with increasing age. Topical agents, including beta blockers, alpha-adrenergic agonists, and prostaglandins, are most commonly used to treat glaucoma. These agents, however, can exacerbate OSD and meibomian gland dysfunction,2,3 and thereby reduce patient compliance with treatment. When it comes to using glaucoma drops in these patients, less is more, as many studies have demonstrated poor adherence as a leading issue in chronic glaucoma therapy.4
Reducing the number of applications by employing fixed-combination products or using products with either alternative preservative (non-BEK) or preservative-free agents are both useful maneuvers. However, selective laser trabeculoplasty (SLT) is also proving to be an excellent first-line therapy or adjunctive option for glaucoma or ocular hypertension; several high-quality studies support SLT from efficacy, quality of life, and cost standpoints.5,6
Indeed, I almost always offer SLT as a treatment option, especially to patients who present for consultation already on topical or oral therapy for OSD. Such circumstances make my conversation regarding glaucoma management more encompassing. Most patients, moreover, find it compelling to learn that topical treatment for glaucoma could worsen their OSD, and they often agree that SLT makes for a more sensible treatment option.
A Wealth of Benefits
SLT also improves treatment compliance through lower cost, higher tolerability, and excellent efficacy. In some cases, out-of-pocket costs for patients using their medical coverage for SLT are lower than purchasing drops, especially if these patients are on Medicare Part D for medication coverage. SLT also offers more comfort and, potentially, improved vision, as well as efficacy that equates to that of prostaglandins, with none of the peak-trough effects associated with these topical agents.
When managing glaucoma, it’s important not to underestimate the impact that OSD can have on the patient’s perception of the care you are providing. It is also important to remember the profound effect dry eye can have on a patient’s quality of life, including workplace performance and presenteeism.7 Consider your therapeutic choices when managing glaucoma and how it may affect the patient’s OSD. The ramifications for the patient can be far more than you might realize.
1. Zemba M, Papadatu CA, Enache VE, Sârbu LN. [Ocular surface in glaucoma patients with topical treatment]. Oftalmologica; 2011; 55(3): 94-98.
2. Erb C. Prevalence of dry eye disease in glaucoma. Eur Ophthalmic Rev. 2009;3(02):49.
3. Cho WH, Lai IC, Fang PC, et al. Meibomian gland performance in glaucomatous patients with long-term instillation of IOP-lowering medications. J Glaucoma. 2018;27(2):176-183.
4. Nordstrom BL, Friedman DS, Mozaffari E, Quigley HA, Walker AM. Persistence and adherence with topical glaucoma therapy. Am J Ophthalmol. 2005;140(4):598-606.
5. Katz LJ, Steinmann WC, Kabir A, et al. Selective laser trabeculoplasty versus medical therapy as initial treatment of glaucoma: a prospective, randomized trial. J Glaucoma. 2012;21(7); 460-468.
6. Gazzard G, Konstantakopoulou E, Garway-Heath D,et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019;393(10180):1505-1516.
7. Nichols KK, Bacharach J, Holland E, et al. Impact of dry eye disease on work productivity, and patients' satisfaction with over-the-counter dry eye treatments. Invest Ophthalmol Vis Sci. 2016;57(7):2975-2982.
Dr. Bacharach, a specialist in glaucoma treatment, is the founder of North Bay Eye Associates, based in Petaluma, Calif.