Abysheva L. D.¹, Avdeev R. V.², Alexandrov A. S.³, Arapiev M. U.⁴, Bakunina N. A.⁵, Baranova N. A.³, Basinskiy A. S.⁶, Brezhnev A. Yu.⁷, Gazizova I. R.⁸, Galimova A. B.⁹, Gapon’ko O. V.^{3, 10}, Gar’kavenko V. V.¹¹, Getmanova A. M.¹², Gorodnichiy V. V.³, Gusarevitch A. A.¹³, Dorofeev D. A.¹⁴, Zhavoronkov S. A.¹⁵, Zavadskiy P. Ch.¹⁶, Zakharova M. A.³, Zakhidov A. B.¹⁷, Zvereva O. G.^{18, 19}, Isakov I. N.²⁰, Karimov U. R.²¹, Kondrakova I. V.³, Kuroyedov A. V.^{3, 10}, Lanin S. N.²², Lovpache Dzh. N.⁴, Loskutov I. A.²³, Molchanova E. V.²⁴, Nagornova Z. M.²⁵, Onufriychuk O. N.²⁶, Petrov S. Yu.²⁷, Rozhko Yu. I.²⁸, Seleznev A. V.²⁵, Tashtitova L. B.¹, Khohlova A. S.²⁹, Shaposhnikova I. V.³⁰, Shahalova A. P.³¹

¹Kazakh Scientific Research Institute of Eye Diseases, Almaty, Kazakhstan; ²State Medical Academy named after N. N. Burdenko, Voronezh, Russia; ³Central Military Clinical Hospital named after P. V. Mandryka, Moscow, Russia; ⁴Moscow Scientifc Research Institute of Eye Diseases named after Helmholtz, Moscow, Russia; ⁵City Clinical Hospital No 1 named after N. I. Pirogov, Moscow, Russia; ⁶Ophthalmological Center of S. N. Basynskiy, Ltd., Orel, Russia; ⁷State Medical University, Kursk, Russia; ⁸North-West Federal Medical and Research Center, Saint-Petersburg, Russia; ⁹All-Russian Eye and Plastic Surgery Center, Ufa, Russia; ¹⁰Russian National Research Medical University named after N. I. Pirogov, Moscow, Russia; ¹¹State Medical University named after V. F. Voyno-Yasenetskiy, Krasnoyarsk, Russia; ¹²Regional Hospital No 1, Bryansk, Russia; ¹³Regional Railway Clinical Hospital, Novosibirsk, Russia; ¹⁴Regional Ophthalmological Clinical Hospital No 3, Chelyabinsk, Russia; ¹⁵City Hospital No 15 named after O. M. Filatov, Moscow, Russia; ¹⁶Medical Center “New Vision” Minsk, Belarus; ¹⁷Ophthalmosurgery Medical Center “SAIF-OPTIMA”, Tashkent, Uzbekistan; ¹⁸Regional Clinical Ophthalmological Hospital, Kazan, Russia; ¹⁹State Medical Academy, Kazan, Russia; ²⁰Diagnostic and Treatment Center of “NZRMK named after N. E. Kryukov”, Novokuznetsk, Russia; ²¹Regional Ophthalmological Hospital, Gulistan, Uzbekistan; ²²Ophthalmological Clinical Hospital named after P. G. Makarov, Krasnoyarsk, Russia; ²³Russian Railway Clinical and Research Medical Center, Moscow, Russia; ²⁴State Medical Academy, Omsk, Russia; ²⁵State Medical Academy, Ivanovo, Russia; ²⁶Ophthalmic Diagnostic City Center No 7, Saint-Petersburg, Russia; ²⁷Scientific and Research State Ophthalmological Institute, Moscow, Russia; ²⁸State Hospital, Gomel, Belarus; ²⁹Pacific State Medical University, Vladivostok, Russia; ³⁰Medical Clinical Center “Good Visionˮ, Kemerovo, Russia; ³¹Medical Clinical Center “Tonus Amarisˮ, Nizhny Novgorod, Russia

Abstract

Aim. To determine the characteristics of dry eye syndrome (DES) onset and progression in patients with primary open-angle glaucoma (POAG), depending on the disease stage, treatment regimens and patient age. 

 Patients and methods. The final protocol of combined analytical multicenter cohort study conducted from January to May 2016 included data of 530 persons (866 eyes): 398 patients with POAG and 132 patients without signs of glaucoma. Ophthalmic examination with the aim to verify glaucoma diagnosis included tonometry, morphometric analysis (optical coherence tomography), functional visual field loss analysis (Humphrey perimetry). DES diagnostic tests included tear film break-up time test (TBUT), Schirmer’s test, lissamine green staining and ocular surface disease index (OSDI) test.

 Results. Prevalence of DES among glaucoma patients aged 51–60, 61–70 and 71–80 years was 9.5, 27.8 and 5.2 % respectively higher, than in control groups of the same age. The stability of the preterminal tear film in all age categories in patients with glaucoma was statistically significantly less than in the comparison group (p < 0.05). The results of the Schirmer test were lower in glaucoma patients compared with the control group as a whole, with statistically significant differences in age subgroups of 41–50 years and 61–70 years (p < 0.05). Frequency and severity of conjunctival and corneal epithelium damage, detected by lissamine green staining, were more expressed in medically treated glaucoma eyes (p < 0.05). No correlation was found between the severity of the DES clinical features and glaucoma stage according to the results of the “classicˮ tests (Schirmer and TBUT). The severity of objective DES symptoms depends on the medical treatment regimen. Significantly lower tear production and tear film stability were associated with the most intensive treatment regimens (combination treatment using 2 and more components) characterized by maximum amount of instillations per day. The intensity of complaints at the stage of the final examination is directly proportional to the duration of drug therapy of glaucoma.

 Conclusion. Ophthalmologists have to take into account the possible onset and progression of DES when they plan glaucoma medical treatment strategy. This will minimize the degree of discomfort, improve quality of life and compliance of these patients and, ultimately, provide better and more effective treatment of glaucoma.

Keywords: glaucoma, dry eye syndrome, ocular surface disease, treatment regimen. 

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Received: 29 June 2017

Published: December 2017