I
REVOLUTION IN GUCOMA MEDICATIONS
N FOCUS
64 | EYEWORLD | MAY 2020
Contact
Muir: kelly.muir@duke.edu
Noecker: noeckerrj@gmail.com
Robin:
arobin@glaucomaexpert.com
Wallace:
danajwallace@gmail.com
He also pointed to the recently approved
Durysta bimatoprost implant, which he thinks
will be helpful for some groups of patients be-
cause it requires no eye drop to be delivered.
Dr. Noecker stressed that the fewer med-
ications you're putting on the eye to keep the
preservative amount down, the better. However,
he noted that there are other options, including
SLT, preservative-free medications, and decreas-
ing the drop count. "We can customize therapy
for a given patient," he said. "These days, we
have more treatment options."
are exposed to in a day. "Combination agents
are nice in this regard, as they may offer fewer
drops per day, but I don't usually start with a
combination agent in a previously untreated
patient," she said. "Each patient is different and
may tolerate one medicine better than another,
and starting (or stopping) multiple medications
at once muddies the picture."
Dr. Muir checks the medical record to see
if a patient can't tolerate a particular medica-
tion and why so that she doesn't inadvertently
reintroduce that medication years down the
road. Non-preserved formulations are often
better tolerated, especially if a patient requires
multiple medications for pressure control.
Unfortunately, they are often cost-prohibitive
for many patients. Additionally, patients may be
hesitant to use artificial tears if they have been
prescribed glaucoma drops unless physicians ex-
plicitly tell them that they are OK to use both.
"I tell patients on glaucoma drops that
they can use artificial tears (preferably preserva-
tive-free) as often as they like, just not immedi-
ately after their glaucoma drops," Dr. Muir said.
In some people, it can make a true differ-
ence to switch to non-preserved medications,
Dr. Robin said. However, he noted that one
barrier often may be the cost of these products.
"They are usually more expensive and harder to
get," he said.
continued from page 63
Relevant disclosures
Muir: None
Noecker: Novartis, Aerie Phar-
maceuticals, Bausch + Lomb,
Allergan, Alcon
Robin: None
Wallace: None
"Patients may also have difficulty
adhering to glaucoma medica-
tions because they don't appre-
ciate any improvements in their
vision or other ocular symptoms
when taking medications."
—Dana Wallace, MD
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