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Prevalence of Ocular Surface Complaints in Patients With Glaucoma Using Topical Intraocular Pressure-Lowering Medications

Fechtner, Robert D MD; Godfrey, David G MD; Budenz, Donald MD; Stewart, Jeanette A RN; Stewart, William C MD; Jasek, Mark C PhD

doi: 10.1097/ICO.0b013e3181c325b2
Clinical Science

Purpose: To determine the prevalence of ocular surface disease (OSD) in patients with glaucoma using topical intraocular pressure (IOP)-lowering therapy.

Methods: This prospective observational study enrolled patients with primary open-angle glaucoma or ocular hypertension who were on a topical IOP-lowering medication regimen. Enrolled patients completed the ocular surface disease index (OSDI) and OSDI scores (0-100, with 0 representing no symptoms) were calculated for each patient. Medical history, demographics, and concomitant medication information were also collected.

Results: Overall, 630 patients from 10 sites participated. Of these, 305 patients (48.4%) had an OSDI score indicating either mild (n = 134, 21.3%), moderate (n = 84, 13.3%), or severe (n = 87, 13.8%) OSD symptoms. OSDI scores were significantly different between patients with and without a prior diagnosis of dry eye syndrome (25.2 ± 15.4 vs 15.4 ± 15.8, respectively; P = 0.0036) and between patients who did and did not use artificial tears at the time of study participation (23.0 ± 15.6 vs 15.3 ± 15.8, respectively; P = 0.0046). Mean OSDI scores varied significantly with the number of topical IOP-lowering medications used, with higher (more severe) OSDI scores in patients using multiple IOP-lowering medications. Specifically, patients on a single medication had a mean OSDI score of 12.9 ± 13.1, which was significantly lower than those of patients on 2 (16.7 ± 17.0; P = 0.007) or 3 medications (19.4 ± 18.1; P = 0.0001).

Conclusions: OSD is prevalent among medically treated patients with glaucoma. The severity of OSD symptoms is positively correlated to the number of IOP-lowering medications used.

From the *Department of Ophthalmology, New Jersey Medical School, Newark, NJ; †Glaucoma Associates of Texas, Dallas, TX; ‡Bascom Palmer Eye Institute, University of Miami, Miami, FL; §PRN Pharmaceutical Research Network, LLC, Dallas, TX; and ¶Alcon Laboratories, Inc, Fort Worth, TX.

Received for publication May 9, 2009; revision received August 12, 2009; accepted September 23, 2009.

Supported by Alcon Laboratories, Inc, Fort Worth, TX.

Reprints: Jeanette A. Stewart, RN, PRN Pharmaceutical Research Network, LLC, 5430 LBJ Freeway, Suite 1200, Dallas, TX 75240 (e-mail:

Copyright © 2010 Wolters Kluwer Health, Inc. All rights reserved.