It’s a delicate balance between quality of life and therapeutic intervention

As the U.S. population ages and generations like the Baby Boomers embrace active lifestyles, eye care professionals may see these lifestyle changes present as more frequent contact lens wear among a population increasingly at risk for developing glaucoma.

To meet these patients’ wants and needs, optometrists must strike a balance between quality-of-life considerations and addressing medical eye care needs therapeutically. Here are the options:

DISCUSS INSTILLATION AND INSERTION PLANS

Because a first-line treatment for glaucoma is typically topical medication, we need to educate our patients on proper use: Lenses should be removed prior to instilling eye drops. It is the recommendation of the FDA to wait 15 minutes before re-inserting contact lenses.

PRESERVE OCULAR SURFACE HEALTH

The use of topical medication may contribute to dry eye disease (DED). Therefore, optometrists should consider ways to preserve these patients’ ocular surface health, so they can remain in contact lenses. This concern is noteworthy because we are generally dealing with an older population that has other factors, such as medication use, contributing to DED risk. When addressing the ocular surface and glaucoma, preventing the progression of glaucoma must take priority, but we can simultaneously consider ways to reduce ocular discomfort secondary to topical therapy. Options include:

• Reducing the number of medications used.¹ To reduce toxicity to the ocular surface, limiting the number of drops taken, without risking an elevation in IOP, is an option. It’s no secret that some glaucoma drops contain preservatives, such as benzalkonium chloride. Prostaglandin analogues can be effective as a monotherapeutic approach.² When additional drops are required, fixed combination drugs are a way to reduce the number of drops needed. Further, glaucoma medications are available that are completely free of preservatives. Barriers to this route may be financial concerns and restrictions by insurance providers.
• Consider other IOP-lowering therapies. Oral medications, laser therapy and surgical interventions, such as selective laser trabeculoplasty, which is gaining momentum as a first-line therapy, are worth discussing with patients. These options may allow for continued contact lens wear, while also addressing ocular hypertension and glaucoma.

TAKE A HOLISTIC APPROACH

It is necessary to choose the most efficient treatment that will not compromise the ocular surface, while still meeting your patients’ desires for correcting their refractive errors. Whether it is offering modifications in topical treatment or considering other therapeutic options, we need to continue to take an holistic approach when treating patients who have multiple conditions. OM

REFERENCES

1. Rossi GC, Pasinetti GM, Scudeller L, Raimondi M, Lanteri S, Bianchi PE. Risk factors to develop ocular surface disease in treated glaucoma or ocular hypertension patients. Eur J Ophthalmol. 2013;23(3):296-302. doi: 10.5301/ejo.5000220.
2. Tang W, Zhang F, Liu K, Duan X. Efficacy and safety of prostaglandin analogues in primary open-angle glaucoma or ocular hypertension patients: A meta-analysis. Medicine (Baltimore). 2019;98(30):e16597. doi: 10.1097/MD.0000000000016597. PMID: 31348303; PMCID: PMC6709278.

DR. COMPTON owns three private practices, Compton Eye Associates in the New York City area. He is the president/founder of TheRightContact.com , a contact lens resource used by eye care professionals. He reports no financial disclosures.