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.
Similar content being viewed by others
References
Ausayakhun S, Louthrenoo W, Aupapong S (2002) Ocular diseases in patients with rheumatic diseases. J Med Assoc Thai 85:855–862
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
Baudouin C (1996) Side effects of antiglaucomatous drugs on the ocular surface. Curr Opin Ophthalmol 7:80–86 doi:10.1097/00055735-199604000-00014
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
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
Brewitt H (1990) Scanning electron microscopic study on local cornea tolerance of beta-blocker eye drops with and without preservatives. Ophthalmologica 201:152–161
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
Broadway DC, Grierson I, Hitchings R (1993) Adverse effects of topical antiglaucoma medication. Arch Ophthalmol 112:1446–1454
Burstein NL (1980) Preservative cytotoxic threshold for benzalkonium chloride and chlorhexidigluconate in cat and rabbit corneas. Invest Ophthalmol Vis Sci 19:308–313
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
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
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
Detry-Morel M (2006) Side effects of glaucoma medications. Bull Soc Belge Ophtalmol 299:27–40
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
Hamideh F, Prete PE (2001) Ophthalmologic manifestations of rheumatic diseases. Semin Arthritis Rheum 30:217–241 doi:10.1053/sarh.2001.16639
Herreras JM, Pastor JC, Calonge M, Asensio VM (1992) Ocular surface alteration after long-term treatment with an antiglaucomatous drug. Ophthalmology 99:1082–1088
Höh H, Schirra F, Kienecker C, Ruprecht KW (1995) Lidkantenparallele conjunctival Falten sind ein sicheres diagnostisches Zeichen des trockenen Auges. Ophthalmologe 92:802–808
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
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
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
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
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
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
Leske MC, Connell AM, Schachat AP, Hyman L (1994) The Barbados eye study. Prevalence of open-angle glaucoma. Arch Ophthalmol 112:821–829
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
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
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
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
Norn MS, Opauszki A (1977) Effects of ophthalmic vehicles on the stability of the precorneal film. Acta Ophthalmol (Copenh) 55:23–24
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
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
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
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
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
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
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
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
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
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
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
Sponsoring organizations: Chibret Pharmazeutische GmbH
Rights and permissions
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-008-0881-9