Glaucoma Specialists Seek Training to Manage Associated Dry Eye

20 January 2020, Baden-Wuerttemberg, —: A doctor marks the eye of a patient during an examination (posed scene). Photo: Marijan Murat/dpa (Photo by Marijan Murat/picture alliance via Getty Images)
The majority of specialists do not believe that ocular surface disease is being adequately managed in glaucoma practices

Glaucoma specialists need more tools and training regarding the assessment and management of ocular surface disease (OSD), according to findings published in the Journal of Glaucoma.

Researchers analyzed a cross-sectional survey that polled 36 glaucoma specialists about their performance in managing glaucoma-associated OSD. Respondents were asked to rank their attitudes toward OSD assessment and management on a scale of 1 to 7, with 1 meaning “strongly disagree” and 7 meaning “strongly agree.”

Survey respondents included ophthalmologist members of the Canadian Glaucoma Society with fellowship training in glaucoma, and the researchers consolidated their responses. They found that 100% of the respondents agreed that comprehensive management of OSD could improve the quality of life of patients with glaucoma, and 97% believed it could lead to better glaucoma outcomes. However, only 22% agreed that glaucoma practices are adequately managing it presently. 

The study explains that OSD affects approximately 1 in 4 Canadians, and about 1 in 225 individuals experience severe symptoms. Because of its ability to negatively affect patients with glaucoma, specialists have developed a burgeoning interest in treating concomitant OSD complaints.

“OSD has been shown to significantly decrease glaucoma-related quality of life scoring compared with controls and has been postulated to have adverse effects on medication adherence,” the researchers explain. “Recent evidence has shown that stabilization of the ocular surface through OSD treatment in patients with glaucoma may improve intraocular pressure (IOP) control and contribute to disease stabilization.”

The study offers some steps necessary for glaucoma specialists to effectively treat OSD going forward, such as the optimization of topical therapies such as benzalkonium chloride (BAK), artificial tears, tear gel, and external eyelid heating devices. Additionally, the researchers say that enhancing ocular surface therapy, stabilizing the ocular surface and, if necessary, surgical intervention are subsequent treatments that could improve the ocular health of patients with glaucoma-related OSD.

A limitation of the study, in addition to its small sample size, was the fact that the researchers made no distinction among types of glaucoma in the suggested treatment algorithm. Additionally, the study did not probe knowledge or attitudes toward point-of-care diagnostic testing modalities for OSD, although they may represent future research avenues.

Disclosure: Several study authors declared affiliations with the biotech or pharmaceutical industries. Please see the original reference for a full list of authors’ disclosures.


Muzychuk A, Racine L, Robert MC, et al. Management of ocular surface disease in glaucoma: a survey of Canadian glaucoma specialists. J Glaucoma. 2020;29(12):1162-1172. doi:10.1097/IJG.0000000000001659.