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    Beyond IOP in glaucoma treatment


    Proactive communications

    The key to successful treatment is communication. Patients are probably not aware that there are contraindications to prostaglandins. The clinician must be proactive in screening for factors, such as pregnancy, recent ocular surgery, active uveitis, recent herpes activity, and other events that require a change or a halt to prostaglandin use.

    Cosmetic appearance has emerged as a significant issue, especially for patients who are using prostaglandins in only one eye. Unilateral dosing typically brings unilateral changes, such as hyperemia, thickened eyelashes, and darkening of the skin beneath the eye. It is easier to ignore, or at least to accept, these cosmetic changes if they affect both eyes, but a dramatic change to just one eye is more difficult for patients.

    There is also increasing evidence that long-term prostaglandin use may be associated with orbital fat loss. Significant fat loss can affect both the cosmetic appearance of the face and visual functioning.

    Preservatives are a real issue in ophthalmic medications. The most common ophthalmic preservative, benzalkonium chloride (BAK), can exacerbate ocular surface disease.

    “In patients with ocular surface disease, you want to make a conscious effort to reduce BAK load, especially in patients who are taking multiple medications,” Dr. Stamper advised. “One can consider agents, such as Travatan Z or Zioptan, that use a preservative other than BAK or none at all in these patients. It may also be worthwhile to remember that generic medications can be compounded without any preservative by a compounding pharmacy.”

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