Ocular surface disease (OSD) is a frequent disabling challenge among patients with glaucoma who use benzalkonium chloride (BAK)-containing topical glaucoma medications for prolonged periods. In this comprehensive review, we evaluated the prevalence of OSD and its management, focusing on both current and future alternatives. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were used to assess a) the impact of active ingredients and preservatives on the ocular surface and b) the efficacy of preservative-free (PF) alternatives and adjunctive therapies. BAK-containing glaucoma medications were found to significantly contribute to OSD by increasing corneal staining, reducing tear film stability, and elevating ocular surface disease index (OSDI) scores. Transitioning to PF formulations or those with less cytotoxic preservatives, such as Polyquad (R) and SofZia (R), demonstrated a marked improvement in OSD symptoms. In particular, the use of adjunct cyclosporine A, through its anti-inflammatory and enhanced tear film stability actions, was shown to be very beneficial to the ocular surface. Therefore, the most effective management of OSD is multi-factorial, consisting of switching to PF or less cytotoxic medications, adjunct use of cyclosporine A, and early incorporation of glaucoma surgical treatments such as laser trabeculoplasty, trabeculectomy, glaucoma drainage devices, or minimally invasive glaucoma surgery (MIGS).
Managing Ocular Surface Disease in Glaucoma Treatment: A Systematic Review
Creators
Ozlem Evren Kemer - Bilkent University
Priya Mekala - The University of Texas Southwestern Medical Center
Bhoomi Dave - Drexel University, College of Medicine
Karanjit Singh Kooner - The University of Texas Southwestern Medical Center
Publication Details
Bioengineering (Basel), v 11(10), 1010
Publisher
Mdpi
Number of pages
24
Grant note
UL1TR001105 / National Center for Advancing Translational Sciences of the National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS)
Research to Prevent Blindness (RPB), New York, NY, USA;
NIH/NEI Core Grant for Vision Research
Resource Type
Journal article
Language
English
Academic Unit
College of Medicine
Web of Science ID
WOS:001341995700001
Scopus ID
2-s2.0-85207666938
Other Identifier
991022005887804721
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Collaboration types
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Web of Science research areas
Biotechnology & Applied Microbiology
Engineering, Biomedical
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