Clinical Scorecard: Glaucoma: A New Prescribing Mindset

At a Glance

Key Highlights

• BAK-containing drops can worsen dry eye disease, increasing nonadherence.
• Nonadherence is nearly 3 times higher with preserved drops compared to preservative-free.
• Long-term BAK exposure leads to meibomian gland dysfunction.
• Clinical signs of DED include punctate keratitis and fluctuating vision.
• Consider selective laser trabeculoplasty as a first-line treatment for patients with DED.

Guideline-Based Recommendations

Diagnosis

• Assess for dry eye disease in glaucoma patients.

Management

• Consider switching to preservative-free drops or laser treatment for patients with DED.

Monitoring & Follow-up

• Monitor for signs of ocular surface disease and patient adherence.

Risks

• Increased risk of corneal staining and inflammation with BAK-containing drops.

Patient & Prescribing Data

Glaucoma patients, especially those diagnosed with dry eye disease.

Switching to laser treatment may improve adherence and ocular surface health.

Clinical Best Practices

• Evaluate the ocular surface health of glaucoma patients regularly.
• Educate patients on the importance of adherence and potential side effects of medications.
• Consider the long-term effects of glaucoma medications on the ocular surface.

References

• Wolfram et al. Patient-reported nonadherence with glaucoma therapy.
• Leung et al. Prevalence of ocular surface disease in glaucoma patients.
• Arita et al. Comparison of the long-term effects of various topical anti-glaucoma medications on meibomian glands.