![]() The major disadvantage of preservative-free therapy is its cost. ![]() They decreased ocular surface inflammation, improved tear osmolarity, and reduced dry eye complaints. ![]() Zioptan must be stored refrigerated at 2º to 8☌ (36º-46☏).Īll three preservative-free solutions were better tolerated than their BAK-preserved counterparts. Once it is opened, medication is applied to the eye, and patients should then immediately discard the container and its remaining contents. Because of the lack of antimicrobial activity in the solution, all of these products are supplied as a sterile solution in a single-use container. Three topical glaucoma medications completely free of preservatives are available in the United States: Zioptan (tafluprost ophthalmic solution 0.0015% Akorn), Cosopt PF (dorzolamide-timolol ophthalmic solution 2%/0.5% Akorn), and Timoptic in Ocudose (timolol maleate ophthalmic solution 0.25% and 0.5% Valeant Pharmaceuticals). Sheri Rowen, MD, and Steven Vold, MD, discuss identifying and preventing dry eye disease in glaucoma patients in this episode of Glaucoma Today Journal Club. Noecker et al showed that brimonidine Purite 0.15% produced less conjunctival lymphocytic infiltration than latanoprost, timolol, or dorzolamide. When the drop is instilled into the eye, light exposure causes the stabilized oxychloro complex to dissociate into nontoxic natural tear components. 11Īlphagan P is preserved with Purite, a stabilized oxychloro complex that has broad antimicrobial activity through oxidative damage. 10 In one study, Travatan Z resulted in less keratopathy and less conjunctival hyperemia than did travoprost preserved with BAK. When exposed to the tear film, SofZia is inactivated by enzymes. SofZia causes microbial death through oxidative damage. Travatan Z is preserved with SofZia, which contains borate, zinc, and sorbitol. The two options currently available in the United States are Travatan Z (travoprost ophthalmic solution 0.004% Alcon) and Alphagan P (brimonidine tartrate ophthalmic solution, 0.1% or 0.15% Allergan). The goal with these products is to maintain an antimicrobial environment in a multidose container while minimizing toxicity to the ocular surface. The study also showed no significant change in IOP from prestudy levels. Goldberg at al found that patients who switched to BAK-free medications needed fewer lubricant drops and reported an improvement in dry eye symptoms. 7,8 There is thus a clear need for BAK-free glaucoma treatment options to minimize OSD and to improve patients’ quality of life. ![]() It is no surprise, then, that the prevalence of OSD among individuals with glaucoma is high, with roughly half of all patients on long-term glaucoma therapy reporting adverse ocular symptoms. 6 Furthermore, the toxic effect of BAK is additive, and patients who must use two or more medications have worse OSD. The prolonged use of BAK-preserved drops is a strong risk factor for OSD in patients with glaucoma.
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