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German register for glaucoma patients with dry eye. I. Basic outcome with respect to dry eye

  • Glaucoma
  • Published:
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Abstract

Background

The purpose of this register was to determine the links between glaucoma, age, concomitant disease, medication, and dry eye in a large group of glaucoma patients.

Methods

A total of 20,506 patients from 900 centers across Germany were included. The first 30 consecutive glaucoma patients at each center were recruited. Epidemiological data as well as information on glaucoma, medication, concomitant diseases, dry eye, and local symptoms were elicited by means of a questionnaire. We analyzed primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and pigmentary glaucoma (PDG).

Results

According to the register data, more women develop dry eye and glaucoma than men (56.9 vs. 45.7%). The most frequent concomitant systemic diseases were hypertension (48.1%), diabetes mellitus (22.5%), and dry mouth, nose, and skin (11.3%). As expected, the highest incidence of dry eye was found in those patients with dry mouth, nose, and skin. Dry eye occurred with dissimilar frequencies in association with the various glaucoma types: PEX>POAG>PDG. The incidence of dry eye increases with age. The gender difference in the occurrence of dry eye becomes apparent from the age of 50. Dry eye occurred more frequently when three or more antiglaucoma drugs were used and increased with the duration of glaucoma disease.

Conclusions

We publish the first results from the German Glaucoma and Dry Eye Register. We found that the occurrence of dry eye is linked to several factors. Thus, the type of glaucoma has an impact on the risk of dry eye. The quantity of eye drops applied also plays a role in the development of the dry eye syndrome if more than three medications are used. While POAG is usually treated with one drug, PEX and PDG tend to be treated with multiple drugs. The gender difference in the occurrence of dry eye becomes apparent from the age 50 years. Because of the vicious circle of dry eye, antiglaucoma eye drops containing benzalkonium chloride compromises patient compliance. The results of the register are therefore of key relevance for the care of glaucoma patients.

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References

  1. Ausayakhun S, Louthrenoo W, Aupapong S (2002) Ocular diseases in patients with rheumatic diseases. J Med Assoc Thai 85:855–862

    PubMed  Google Scholar 

  2. Baudouin S, Garcher C, Haouat N, Bron A, Gastaud P (1994) Expression of inflammatory membrane markers by conjunctival cells in chronically treated patients with glaucoma. Ophthalmology 101:454–460

    PubMed  CAS  Google Scholar 

  3. Baudouin C (1996) Side effects of antiglaucomatous drugs on the ocular surface. Curr Opin Ophthalmol 7:80–86 doi:10.1097/00055735-199604000-00014

    Article  PubMed  CAS  Google Scholar 

  4. Baudouin S, Pisella PJ, Fillacier K, Goldschild M, Becquet F, De Saint Jean M et al (1999) Ocular surface inflammatory changes induced by topical antiglaucoma drugs: human and animal studies. Ophthalmology 106:556–563 doi:10.1016/S0161-6420(99)90116-1

    Article  PubMed  CAS  Google Scholar 

  5. Brandt JD, Wittpenn JR, Katz LJ, Steinmann WN, Spaeth GL (1991) Conjunctival impression cytology in patients with glaucoma using long-term topical medication. Am J Ophthalmol 112:297–301

    PubMed  CAS  Google Scholar 

  6. Brewitt H (1990) Scanning electron microscopic study on local cornea tolerance of beta-blocker eye drops with and without preservatives. Ophthalmologica 201:152–161

    Article  PubMed  CAS  Google Scholar 

  7. Broadway DC, Bates AK, Lightman SL, Grierson I, Hitchings RA (1993) The importance of cellular changes in the conjunctiva of patients with uveitic glaucoma undergoing trabeculectomy. Eye 7:495–501

    Article  PubMed  Google Scholar 

  8. Broadway DC, Grierson I, Hitchings R (1993) Adverse effects of topical antiglaucoma medication. Arch Ophthalmol 112:1446–1454

    Article  Google Scholar 

  9. Burstein NL (1980) Preservative cytotoxic threshold for benzalkonium chloride and chlorhexidigluconate in cat and rabbit corneas. Invest Ophthalmol Vis Sci 19:308–313

    PubMed  CAS  Google Scholar 

  10. Cackett P, Vallance J, Cobb C, Devlin H, Simpson A, Sanders R (2005) South-East Scotland trabeculectomy survey. Eye advance online publication doi:10.1038/sj.eye.6702118

  11. Champeau EJ, Edelhauser HF (1986) Effect of ophthalmic preservations on the ocular surface: conjunctival and corneal uptake and distribution of benzalkonium chloride and chlorhexidine digluconate. In: Holly FJ, Lemp MA (eds) The preocular tear film in health, disease and contact lens wear. Little, Brown & Co, pp 292–302

    Google Scholar 

  12. De Jong C, Solwijk T, Kuppens E, de Keizer R, van Best J (1994) Topical timolol with and without benzalkonium chloride: epithelial permeability and autofluorescence of the cornea in glaucoma. Graefes Arch Clin Exp Ophthalmol 232:221–224 doi:10.1007/BF00184009

    Article  PubMed  Google Scholar 

  13. Detry-Morel M (2006) Side effects of glaucoma medications. Bull Soc Belge Ophtalmol 299:27–40

    PubMed  Google Scholar 

  14. Erdoğan H, Arici DS, Toker MI, Arici MK, Fariz G, Topalkara A (2006) Conjunctival impression cytology in pseudoexfoliative glaucoma and pseudoexfoliation syndrome. Clin Experiment Ophthalmol 34:108–113 doi:10.1111/j.1442-9071.2006.01168.x

    Article  PubMed  Google Scholar 

  15. Hamideh F, Prete PE (2001) Ophthalmologic manifestations of rheumatic diseases. Semin Arthritis Rheum 30:217–241 doi:10.1053/sarh.2001.16639

    Article  PubMed  CAS  Google Scholar 

  16. Herreras JM, Pastor JC, Calonge M, Asensio VM (1992) Ocular surface alteration after long-term treatment with an antiglaucomatous drug. Ophthalmology 99:1082–1088

    PubMed  CAS  Google Scholar 

  17. Höh H, Schirra F, Kienecker C, Ruprecht KW (1995) Lidkantenparallele conjunctival Falten sind ein sicheres diagnostisches Zeichen des trockenen Auges. Ophthalmologe 92:802–808

    PubMed  Google Scholar 

  18. Kahn HA, Leibowitz HM, Ganley JP, Kini MM, Colton T, Nickerson RS et al (1977) The Framingham eye study. I. Outline and major prevalence findings. Am J Epidemiol 106:17–32

    CAS  Google Scholar 

  19. Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, Hypertension Treatment Study Group et al (2002) The ocular hypertension treatment study. Arch Ophthalmol 120:701–713

    PubMed  Google Scholar 

  20. Klein BE, Klein R, Sponsel WE, Franke T, Cantor LB, Martone J et al (1992) Prevalence of glaucoma. The Beaver Dam study. Ophthalmology 99:1499–1504

    PubMed  CAS  Google Scholar 

  21. Kuppens EV, de Jong CA, Stolwijk RT, de Keizer RJ, van Best JA (1995b) Effect of timolol with and without preservative on the basal tear turnover in glaucoma. Br J Ophthalmol 79:339–342 doi:10.1136/bjo.79.4.339

    Article  PubMed  CAS  Google Scholar 

  22. Kuppens EV, Stolwijk TR, de Keizer RJW, van Best JA (1992) Basal tear turnover and topical timolol in glaucoma patients and healthy controls by fluorophotometry. Invest Ophthalmol Vis Sci 33:3442–3448

    PubMed  CAS  Google Scholar 

  23. Kuppens EV, van Best JA, Sterk CC, de Keizer RJ (1995a) Decreased basal tear turnover in patients with untreated primary open-angle glaucoma. Am J Ophthalmol 120:41–46

    PubMed  CAS  Google Scholar 

  24. Leske MC, Connell AM, Schachat AP, Hyman L (1994) The Barbados eye study. Prevalence of open-angle glaucoma. Arch Ophthalmol 112:821–829

    Article  PubMed  CAS  Google Scholar 

  25. Mainstone JC, Bruce AS, Golding TR (1996) Tear meniscus measurement in the diagnosis of dry eye. Curr Eye Res 15:653–661 doi:10.3109/02713689609008906

    Article  PubMed  CAS  Google Scholar 

  26. Methodologies to diagnose and monitor dry eye disease: Report of the diagnostic methodology subcommittee of the International Dry Eye Workshop (2007). The Ocular Surface 5(2):108–152

  27. Mitchell P, Smith W, Attebo K, Healy PR (1996) Prevalence of open-angle glaucoma in Australia. The Blue Mountains eye study. Ophthalmology 103:1661–1669

    PubMed  CAS  Google Scholar 

  28. Noecker RJ, Herrygers LA, Anwaruddin R (2004) Corneal and conjunctival changes caused by commonly used glaucoma medications. Cornea 23:490–496 doi:10.1097/01.ico.0000116526.57227.82

    Article  PubMed  Google Scholar 

  29. Norn MS, Opauszki A (1977) Effects of ophthalmic vehicles on the stability of the precorneal film. Acta Ophthalmol (Copenh) 55:23–24

    Article  CAS  Google Scholar 

  30. Nuzzi R, Vercelli A, Finazzo C, Cracco C (1995) Conjunctiva and subconjunctiva tissue in primary open-angle glaucoma after long-term topical treatment: an immunohistochemical and ultrastructural study. Graefes Arch Clin Exp Ophthalmol 233:154–162 doi:10.1007/BF00166608

    Article  PubMed  CAS  Google Scholar 

  31. Ohtsuki M, Yokoi N, Mori K, Matsumoto Y, Adachi W, Ishibashi K et al (2001) Adverse effects of beta-blocker eye drops on the ocular surface. Nippon Ganka Gakkai Zasshi 105:149–154

    PubMed  CAS  Google Scholar 

  32. Pisella PJ, Pouliquen P, Baudouin C (2002) Prevalence of ocular symptoms and signs with preserved and preservative free glaucoma medication. Br J Ophthalmol 86:418–423 doi:10.1136/bjo.86.4.418

    Article  PubMed  CAS  Google Scholar 

  33. Quigley HA, Broman AT (2006) The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 90:262–267 doi:10.1136/bjo.2005.081224

    Article  PubMed  CAS  Google Scholar 

  34. Resnikoff S, Pascolini D, Etya’ale D, Kocur I, Pararajasegaram R, Pokharel GP et al (2004) Global data on visual impairment in the year 2002. Bull World Health Organ 82:844–851

    PubMed  Google Scholar 

  35. Sherwood MB, Grierson I, Millar L, Hitchings RA (1989) Long-term effects of antiglaucoma drugs on the conjunctiva and Tenon`s capsule in glaucomatous patients. Ophthalmology 96:327–335

    PubMed  CAS  Google Scholar 

  36. Tielsch JM, Sommer A, Katz J, Royall RM, Quigley HA, Javitt J (1991) Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore eye survey. JAMA 266:369–374 doi:10.1001/jama.266.3.369

    Article  PubMed  CAS  Google Scholar 

  37. Wensor MD, McCarty CA, Stanislavsky YL, Livingston PM, Taylor HR (1998) The prevalence of glaucoma in the Melbourne visual impairment project. Ophthalmology 105:733–739 doi:10.1016/S0161-6420(98)94031-3

    Article  PubMed  CAS  Google Scholar 

  38. Wilson WS, Duncan AJ, Jay JL (1975) Effect of benzalkonium chloride on the stability of the precorneal tear film in rabbit and man. Br J Ophthalmol 59:667–669 doi:10.1136/bjo.59.11.667

    Article  PubMed  CAS  Google Scholar 

  39. Wolfs RCW, Borger PH, Ramrattan RS, Klaver CCW, Hulsman CAA, Hofman A et al (2000) Changing views on open angle glaucoma: definitions and prevalences - the Rotterdam study. Invest Ophthalmol Vis Sci 41:3309–3321

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We wish to thank Chibret Pharmazeutische GmbH for its kind support of the project. Without this financial aid a register of this size would not have been possible.

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Correspondence to Carl Erb.

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Sponsoring organizations: Chibret Pharmazeutische GmbH

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Erb, C., Gast, U. & Schremmer, D. German register for glaucoma patients with dry eye. I. Basic outcome with respect to dry eye. Graefes Arch Clin Exp Ophthalmol 246, 1593–1601 (2008). https://doi.org/10.1007/s00417-008-0881-9

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  • DOI: https://doi.org/10.1007/s00417-008-0881-9

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