Preservative-free IOP-lowering medications of interest to ophthalmologists, survey finds

September 1, 2009

Results of a survey of 124 ophthalmologists show interest in preservative-free formulations of IOP-lowering medications to preserve ocular surface health. Preservative-free timolol maleate (Timoptic in Ocudose, Aton Pharma) can be a good choice for appropriately selected patients, according to one ophthalmologist.

Key Points

"For patients who have ocular surface problems while using topical IOP-lowering medications, it is important to identify whether they have blepharitis and/or dry eye disease and address those conditions with targeted intervention," said William D. Trattler, MD, director of cornea at the Center of Excellence in Eyecare in Miami, who reviewed the survey results for its sponsor, Aton Pharma. "Choosing or switching to preservative-free timolol may also be an appropriate option for managing ocular surface disease in some patients."

The survey was conducted online in March and included a nationwide sample of ophthalmologists. Invitations were sent via e-mail, and only ophthalmologists who treated at least 20 patients with glaucoma per month were asked to participate. The survey was completed by 124 ophthalmologists, including 36 glaucoma specialists and 40 cataract surgeons.

Almost all of the participants (97%) agreed that preservative-free glaucoma medications can enhance the ocular comfort of patients with glaucoma. The data also showed that a supermajority believe that preservative-free glaucoma medications can enhance patient quality of life (87%), and a similarly high proportion of the ophthalmologists (89%) said that not enough preservative-free glaucoma medications were available.

When asked more specifically about product availability, nearly half of respondents (47%) did not know that a preservative-free beta-blocker was available on the market. In addition, almost three-fourths of the ophthalmologists (73%) said that the presence of preservatives affects their decision-making process for glaucoma therapy.

"Survey respondents acknowledged that preservatives in glaucoma medications may be a cause of a number of problems, including ocular surface disease, medication intolerance, and patient noncompliance," Dr. Trattler said. He acknowledged that until he became involved in this project, he also was unaware of the availability of a preservative-free formulation of timolol.

Decision has many factors

Dr. Trattler said that the formulation could be a good option when a beta-blocker is an appropriate therapeutic choice in patients with pre-existing ocular surface disease or those at high risk, such as older patients or those with blepharitis. The decision also must consider the IOP-lowering activity of timolol and contraindications.

"A beta-blocker provides less IOP-lowering than a prostaglandin analogue," he concluded. "However, the preservative-free formulation of timolol maleate may be a reasonable option to help maintain ocular surface health for patients with ocular surface disease or those at risk if they have mildly elevated IOP associated with ocular hypertension or early glaucoma, or when add-on therapy is needed and assuming the patient has no medical contraindications to use of a topical nonselective beta-blocker."