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Clinical and Experimental Ophthalmology 2015; 43: 214–220 doi: 10.1111/ceo.12431
Original Article Clinical audit examining the impact of benzalkonium chloride-free anti-glaucoma medications on patients with symptoms of ocular surface disease Ivan Goldberg AM FRANZCO FRACS,1,2,3 Stuart L Graham PhD FRANZCO,1,3,4 Jonathan G Crowston PhD FRANZCO5,6 and Guy d’Mellow FRANZCO7,8 on behalf of the Australian and New Zealand Glaucoma Interest Group 1
Discipline of Ophthalmology, University of Sydney, 2Glaucoma Unit, Sydney Eye Hospital, 3Eye Associates, 4Australian School Advanced Medicine, Macquarie University, Sydney, New South Wales, 5Department of Ophthalmology, University of Melbourne, 6 Centre for Eye Research Australia, Melbourne, Victoria, 7Terrace Eye Centre and 8Greenslopes Hospital, Brisbane, Queensland, Australia
ABSTRACT Background: Ocular surface disease (OSD) is relatively common in glaucoma patients. OSD symptoms could be linked to prolonged exposure to preservatives in anti-glaucoma medications, especially benzalkonium chloride (BAK). The OBSERVE clinical audit was designed to track the impact of intraocular pressure lowering medications in patients with evidence of OSD to test the hypothesis that BAK-free anti-glaucoma preparations offer clinical advantages over BAK-containing products. Design: Prospective clinical audit from March 2012 to April 2013, open to ophthalmologists practising in Australia. Participants: There were 375 patients enrolled, with a completion rate of 64%. The cohort was predomi-
nantly female (68%) with an average age of 71 years. Methods: Patients were screened for inclusion during a routine consultation. If eligible, they were enrolled. At the ophthalmologist’s discretion, some patients were switched to BAK-free anti-glaucoma products. Data were collected via an online survey completed by the ophthalmologist during three appointments over a 16- to 30-week period for all patients. Main Outcome Measures: Intraocular pressure, tear-film breakup time, McMonnies Dry Eye Questionnaire score and reported lubricant use. Results: Patients who switched to BAK-free preparations reported a significant fall in the use of lubricants (P = 21 Normal: 10–21 High: >21
No switch
Baseline assessment (%)
Secondary assessment (%)
Final assessment (%)
170 (87.2) 25 (12.8) 39 (84.8) 7 (15.2)
178 (91.3) 17 (8.7) 41 (89.1) 5 (10.9)
181 (92.8) 14 (7.2) 42 (91.3) 4 (8.7)
BAK, benzalkonium chloride. © 2014 Royal Australian and New Zealand College of Ophthalmologists
Eye drops and surface disease Table 2.
217
Analysis of variance for the tear film break-up time (seconds) over time
Effect
Degrees of freedom
Chi-squared
Pr > ChiSq
2 2 2
3.37 41.07 4.24
0.1855 10 s) Marginal TBUT(5−10 s)
Baseline
Figure 2. McMonnies Dry Eye Questionnaire score over time for switched cohort.
Secondary Clinical visit
Switched
Non-switched
Switched
Non-switched
Switched
Low TBUT(14.5 at baseline. There was a significant decrease in MMDEQ scores over time in both groups (P =
Clinical and Experimental Ophthalmology 2015; 43: 214–220 doi: 10.1111/ceo.12431
Original Article Clinical audit examining the impact of benzalkonium chloride-free anti-glaucoma medications on patients with symptoms of ocular surface disease Ivan Goldberg AM FRANZCO FRACS,1,2,3 Stuart L Graham PhD FRANZCO,1,3,4 Jonathan G Crowston PhD FRANZCO5,6 and Guy d’Mellow FRANZCO7,8 on behalf of the Australian and New Zealand Glaucoma Interest Group 1
Discipline of Ophthalmology, University of Sydney, 2Glaucoma Unit, Sydney Eye Hospital, 3Eye Associates, 4Australian School Advanced Medicine, Macquarie University, Sydney, New South Wales, 5Department of Ophthalmology, University of Melbourne, 6 Centre for Eye Research Australia, Melbourne, Victoria, 7Terrace Eye Centre and 8Greenslopes Hospital, Brisbane, Queensland, Australia
ABSTRACT Background: Ocular surface disease (OSD) is relatively common in glaucoma patients. OSD symptoms could be linked to prolonged exposure to preservatives in anti-glaucoma medications, especially benzalkonium chloride (BAK). The OBSERVE clinical audit was designed to track the impact of intraocular pressure lowering medications in patients with evidence of OSD to test the hypothesis that BAK-free anti-glaucoma preparations offer clinical advantages over BAK-containing products. Design: Prospective clinical audit from March 2012 to April 2013, open to ophthalmologists practising in Australia. Participants: There were 375 patients enrolled, with a completion rate of 64%. The cohort was predomi-
nantly female (68%) with an average age of 71 years. Methods: Patients were screened for inclusion during a routine consultation. If eligible, they were enrolled. At the ophthalmologist’s discretion, some patients were switched to BAK-free anti-glaucoma products. Data were collected via an online survey completed by the ophthalmologist during three appointments over a 16- to 30-week period for all patients. Main Outcome Measures: Intraocular pressure, tear-film breakup time, McMonnies Dry Eye Questionnaire score and reported lubricant use. Results: Patients who switched to BAK-free preparations reported a significant fall in the use of lubricants (P = 21 Normal: 10–21 High: >21
No switch
Baseline assessment (%)
Secondary assessment (%)
Final assessment (%)
170 (87.2) 25 (12.8) 39 (84.8) 7 (15.2)
178 (91.3) 17 (8.7) 41 (89.1) 5 (10.9)
181 (92.8) 14 (7.2) 42 (91.3) 4 (8.7)
BAK, benzalkonium chloride. © 2014 Royal Australian and New Zealand College of Ophthalmologists
Eye drops and surface disease Table 2.
217
Analysis of variance for the tear film break-up time (seconds) over time
Effect
Degrees of freedom
Chi-squared
Pr > ChiSq
2 2 2
3.37 41.07 4.24
0.1855 10 s) Marginal TBUT(5−10 s)
Baseline
Figure 2. McMonnies Dry Eye Questionnaire score over time for switched cohort.
Secondary Clinical visit
Switched
Non-switched
Switched
Non-switched
Switched
Low TBUT(14.5 at baseline. There was a significant decrease in MMDEQ scores over time in both groups (P =
