Comparison of BAK free Travatan with BAK Preserved Xalatan in Terms of Ocular Surface Disease in Glaucoma patients in our population

Objective: To assess symptoms of ocular surface disease (OSD) in patients treated with a BAK-preserved Xalatan (Latanoprost) to control their intraocular pressure, who either continued that medication or switched to a BAK-free therapy (BAK free Travatan), as well as patients newly placed on BAK free Travatan in our population. Patients & methods: A prospective observational study was conducted at CMH Lahore. Eighty (80) cases 20 years of age or older, with open-angle glaucoma or ocular hypertension were consecutively recruited for the study. Baseline records were documented after taking written informed consent. Every patient completed an Ocular Surface Disease Index questionnaire and underwent evaluation by Schirmer test, corneal and conjunctival fluorescein staining, and tear break-up time. Cases were divided into two groups (A, B). Group A (40 patients) includes those patients who were already using latanoprost (Xalatan) and those who were put on Xalatan monotherapy for the first time. In group B (40 patients) were those who were on Xalatan therapy but now switched to BAK free Travatan and those who were placed on BAK free Travatan antiglaucoma therapy for the first time. Ocular symptoms by OSDI scores were assessed again after 4, 8 and 12 weeks. The patients were queried for ocular symptoms, and ocular signs were assessed by using tear break-up time, Schirmer's test, fluorescein staining and evaluation of conjunctival hyperemia. Results: The study showed that the symptoms of ocular surface disease were significantly lower in the BAKfree travatan 0.004% group (35% of group) than in the BAK-preserved latanoprost (Xalatan) 0.005% group (62.5%% of group) and a significantly larger percentage showed normal OSDI scores in the BAK-free travatan 0.004% group than in the BAK preserved latanoprost 0.005% group. Moreover patients on BAK-preserved latanoprost 0.005% who were switched to BAK-free travatan showed a better OSDI score after 12 weeks. In BAK preserved Latanoprost Group A (67.5%) had abnormal fluorescein staining of cornea, (77.5%) had conjunctival hyperaemia and abnormal Schirmer's test was present in (65%). In BAK free Travatan group B 45%, 52.5%, 37.5% respectively had abnormal results which were significantly less than latanoprost group. The tear break-up time was also better in Travatan group 7.6 +/- 4.9 seconds compared to latanoprost group 4.2 +/- 2.5 seconds. Conclusion: Patients placed on BAK free Travatan showed less symptoms of ocular surface disease as compared to those placed on BAK preserved Latanoprost (Xalatan). Moreover Switching from BAK-preserved latanoprost 0.005% to BAK-free travatan 0.004% yielded significant improvements in symptoms of OSD in patients with glaucoma. Preservative-free travatan treatment resulted in increased patient satisfaction, drop comfort and vision related quality of life in terms of ocular surface disease.