When is preservative-free therapy of glaucoma needed and advisable?

Abstract

Purpose: to estimate the demand for preservative-free medical therapy of glaucoma in real clinical practice as part of the analysis of the compliance of specialized medical care of glaucoma patients and the approved clinical guidelines.Material and methods. Head non-staff ophthalmologists in 34 regions of Russia were surveyed to find out the share of patients with a newly diagnosed primary open-angle glaucoma; systemic contraindications; diseases of ocular surface tissues; using combination therapy if monotherapy proves ineffective. Also, we analyzed the current annual need for glaucoma treatment drugs in Russia and estimated the expected need for these drugs.Results. The survey showed that, on average, (1) 64.35 % of glaucoma patients are prescribed monotherapy; (2) in the presence of systemic contraindications, nonselective beta-blockers are avoided in 85 % of cases; (3) ca. 53 % of glaucoma patients require preservative-free therapy; (4) almost 61 % of patients for whom monotherapy proved ineffective are prescribed combination therapy. As shown by calculated annual and projected demand for antiglaucomatous drugs in 2020, the leading position is taken by timolol (43.96 %), followed by dorzolamide (38.04 %), and tafluprost (11.93 %). Diseases of the ocular surface in glaucoma patients with glaucoma averaged 52.6 % in the surveyed regions.Conclusion. The actual demand for preservative-free therapy in clinical practice in the analyzed regions is higher than the annual and predicted need as it is required by about 54% of all patients with glaucoma. Further epidemiological, pharmacological and economic studies of ocular surface disease incidence in patients with glaucoma and of the demand for preservative-free therapy are required in order to solve the issue of drug supply in regions of Russia.