Eye drops are commonly used for the treatment and ongoing management of glaucoma, with many patients trying to find multiple formulations that prove effective in lowering their intraocular pressure (IOP). Preservatives, including benzalkonium chloride (BAK), are used in approximately 70% of ophthalmic formulations for their antimicrobial properties. However, research shows that long-term exposure to BAK can be toxic to the ocular surface and may cause irreparable damage.1
IYUZEH (latanoprost ophthalmic solution) 0.005% is a prostaglandin F2α analogue indicated for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension. Please see Important Safety Information within and full Prescribing Information here.
Optimizing eye health: why avoid overuse of preservatives?
Chronic preservative exposure impacts eye health in several ways, including damage to the ocular surface. This can lead to ocular surface disease, potentially causing itching, burning, and decreased vision.2 In addition to the significant impact on patients’ quality of life, research shows that those who experience side effects are less likely to adhere to their prescribed treatment regimen. As a result, up to one-third of patients are not getting the full benefit of their prescribed treatment because of poor adherence.3
From a surgical perspective, the results of the Preservative Exposure and Surgical Outcomes (PESO) study show a direct correlation between preoperative exposure to preservatives and poorer outcomes following filtration surgery, demonstrating the lasting impact of frequent preservative use and how it could damage the ocular surface.4
Consequently, as specialists, we have a duty to minimize or eliminate exposure to preservatives within our prescribed treatment regimen where appropriate. Recent advancements in formulation offer treatment options that enable us to reduce the preservative load of a treatment regimen and effectively manage patients’ glaucoma. By adopting this approach, we can protect patients’ eye health while lowering IOP and potentially safeguard future treatment interventions that a patient may require later in the treatment journey. In many cases, this can be achieved by switching patients to a preservative-free formulation for treatment.
Advancements in glaucoma care: when to switch to preservative-free
IYUZEH, recently available in the USA, is the first preservative-free latanoprost for the treatment of open-angle glaucoma and ocular hypertension. In clinical studies, IYUZEH demonstrated clinically meaningful IOP-lowering effects when compared with Xalatan, and was well tolerated throughout the trial.5 In the two clinical trials conducted with IYUZEH the most frequently reported ocular adverse reactions were conjunctival hyperemia and eye irritation. This provides patients with an option that offers the reduction of IOP with a lower incidence of ocular treatment-emergent adverse events.
Our goal is to understand the unique needs of each patient and create a tailored treatment plan that will lead to the best outcomes for that individual. Having a preservative-free option allows us to balance our patients’ overall health and well-being with their long-term treatment and management of glaucoma.
The patient’s IOP was stable; however, he was experiencing redness and irritation in his eyes. In addition to causing the patient significant eye discomfort, this also proved disruptive to his occupation. This made it crucial to address.
As the preservatives in the medication he was using may have been causing the redness, my recommendation was to switch to IYUZEH to reduce the preservative load. As treating the whole patient is very important to me, I also recommended an anti-inflammatory lifestyle to address other factors that could be contributing to increased IOP.
Overall, the patient was very happy with the new treatment regimen. With IYUZEH, his IOP was sustained at an acceptable level and the medication is being well tolerated, with him no longer experiencing redness and irritation.
Following a successful SLT procedure, this patient did not require drops for the first 4 years of her treatment journey. Initially, I prescribed a preserved prostaglandin, which proved effective in lowering IOP to 20–30% below baseline.
Looking forward, as the drops were effective in managing IOP, my priority in this case was to ensure a sustainable long-term treatment plan to continue preventing disease progression. As the patient was likely to remain on eye drops for the foreseeable future, my recommendation was to switch to IYUZEH to help protect the patient’s ocular surface against preventable damage known to be caused by frequent and prolonged exposure to preservatives.
Following the switch, IYUZEH is proving effective in sustaining the 20–30% reduction in IOP. The patient continues to have good overall eye health, and the treatment is being well tolerated.
Why switch to preservative-free IYUZEH?
IYUZEH has demonstrated consistent IOP-lowering effects and proven tolerability across multiple trials in the U.S. and Europe. In randomized, controlled clinical trials of patients with open-angle glaucoma or ocular hypertension with mean baseline IOP of 19-24 mmHg, IYUZEH lowered IOP by 3 – 8 mmHg versus 4 – 8 mmHg by Xalatan, which is preserved with BAK.
In addition, a recent real-world study (where 1872 patients from 6 European countries were treated with preservative-free latanoprost for 3 months) found that, of patients who had switched from a preservative-related treatment, the most common reasons for switching to IYUZEH included local intolerance, insufficient efficacy, possibly due to poor adherence, and poor compliance. In total, 95.3% of patients were satisfied or very satisfied with IYUZEH in terms of tolerability. Additionally, 89.5% of patients found IYUZEH to be easier than or as easy to use as their previous preserved treatment.6
Overall, these real-world data, in addition to our day-to-day clinical experience, highlight IYUZEH as a valuable choice of therapy to address tolerability issues and to help with sustainable long-term management of glaucoma, empowering us to provide optimal care for our patients.
