Dry Eye Hinders Glaucoma Patients on Drops

SAN FRANCISCO, California — Patients with glaucoma who use topical eye drops can have dry eye symptoms that significantly affect their quality of life — particularly if they are black, according to a new study.

"Not only having glaucoma, but also using drops for it can decrease your quality of life," lead researchers Jonathan Tzu, MD, told Medscape Medical News. The study also found that there were clear racial disparities in the effect of glaucoma medications on dry eye and quality of life.

"Even when [black] patients were taking the same number of glaucoma drops as white patients, they had consistently lower quality of life from dry eye," said Dr. Tzu, who is from the Bascom Palmer Eye Institute in Miami, Florida.

For this study, patients at a Miami veterans' health clinic completed 2 questionnaires: the Dry Eye Questionnaire 5 (DEQ5) to assess the presence and severity of dry eye symptoms, and the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire to assess how dry eye affected their quality of life. The results were presented here at the American Glaucoma Society 23rd Annual Meeting.

The study involved 353 patients with glaucoma who were being treated with topical eye drops and 114 patients with no history of ocular surface disease, glaucoma, or topical medications (control group).

Sixty percent of patients using glaucoma medications were black and 39% were white.

Although medication drops can be crucial for preventing the progression of glaucoma, they can cause or worsen dry eye symptoms.

The researchers found that severe dry eye symptoms were more common in patients using glaucoma drops than in those not using them (34% vs 25%). Symptom severity increased with the number of glaucoma drops used (none, 25%; 1 or 2, 27%; 3 or more, 40%).

Patients being treated with glaucoma drops were more likely to report that dry eye negatively affected their emotional wellbeing (P = .007), but not their ability to work or perform daily activities.

Racial Disparity

Among those using glaucoma drops, blacks had significantly lower quality-of-life scores related to dry eye than whites at every level of medication use, according to Dr. Tzu.

"It's not surprising that people who use more glaucoma medications would have more severe dry eye or surface eye disease; it's an unfortunate effect of these medications," said Joel Schuman, MD, professor and chair of the Department of Ophthalmology at the University of Pittsburgh in Pennsylvania.

However, "the racial disparity in this study is a novel finding, and one that clinicians should take into account when treating glaucoma patients," added Dr. Schuman, who was not involved in the study.

When treating black patients, it is particularly important to ask whether they are experiencing adverse effects related to their medications, and to offer other methods for treatment, such as laser trabeculoplasty or surgery, Dr. Schuman pointed out.

"You have to consider the quality of life of the patient when measuring the risk and benefit of a glaucoma treatment," Dr. Schuman said.

Dr. Tzu and Dr. Schuman have disclosed no relevant financial relationships.

American Glaucoma Society (AGS) 23rd Annual Meeting: Abstract 100. Presented March 2, 2013.