DUOTRAV eye drops

[bunnings]

Hi l have been taking Azarga eye drops ( Timolol and Brinzolamide0 for 8 years twice a day with not much side effects except some dry eye, but recently it stopped being as effective in lowering the pressure so my eye specialist also put me on Travatan also ( Travoprost ) so l am now taking azarga twice a day and travatan one a day, the additional travatan has been successful in lowering my presssure but  taking all  these drops making my eyes more dry and slightly sore. L noticed theres a drop called Duotrav which contains timolol and brinzolamide, so l guess it sort of a combination of azarga and travatan .  This is a once a day drop, l was wondering if l were to stop taking the azarga and travatan and instead take DUotrav once a day if it would be as effective but with less side effects. Do you think it might be a good idea to suggest to my eye specialist

[John C Hagan III, MD, FACS, FAAO]

Duotrav contains travapost and timolol.    So you not be taking one of the medicine you now are on (brinzolamide)  and if you only take it once per day you would only be taking half the present timolol dosage. So it would not be an acceptable substitution because you would be on much less medication.   What you should do is discuss the soreness and irritation you are having with your eye specialist. You may need to start using artificial tears.  Ask also about laser treatment (Selective Laser Trabeculoplasty or SLT) to see if the travapost might be stopped. SLT is used extremely often now as a superior substitute for drops.

[bunnings]

Hi yes l tried SLT laser in one eye last and it was'nt succesful, does that mean if l try it again or the other eye it wont work. ALso l currently take artifical tears, they help but dont totally solve the dryness and slight redness. The dryness and slight redness is only really during the night and when l wake up and then it clears during the day . l dont mind putting up with it as long as its not doing any harm to my eyes, can taking so many glaucoma eye drops damage to your eyes long term such as the preservatives,   l think l read BAK long term is not good and can damage the drainage meshwork. ? s that possible?   Can you think of any other glaucoma eye drops l could suggest to my specialist that might work. Also is there a prescription drop for dryness

[John C Hagan III, MD, FACS, FAAO]

First of all be sure you are not sleeping under a fan or have air circulating in your bedroom.    If SLT not work on first eye usually I don't do the second eye.  If your eyes were okay on the Azarga and only started when you added travoprost then the problem is likely the travoprost.   Yes the BAK preservative can be a problem for some people.  Travaprost  has preservatives and maybe BAK.  They do make a preservative free drug in the same family (Latanoprost), in the US it is sold under name Zioptin.  It can be expensive for some insurance plans. Another option would be to put the travaprost in 15-30 minutes before bedtime and at bedtime put an overnight lubricant in like: Refresh PM or other GEL lubricant.  With anyone that wakes up with eyes uncomfortable that gets better during the day I always want to be sure they are not sleeping under a fan and have tried an overnight lubricant.

[bunnings]

thanks, l'm in Australia where all the glaucoma eye drops including preservative free are very cheap under our system . Some places l read BAK can harm your eyes other places l read it does no harm so l am not sure. Anyway l will suggest to my specialist switching to preservative free if its possible , the preservative free drops we have in Australia are Safluton ( Tafluprost) ,  Cosopt, (• Dorzolamide 2%/timolol 0.5%) , : Ganfort ( Bimatoprost 0.03%/timolol 0.5) . Do you think any of these alone or as a combination would be a good replacement for  the azarga and travatan, thanks

[John C Hagan III, MD, FACS, FAAO]

None are equivalent as you are on 3 meds and they only contain 2.   BAK is a very effective and inexpensive preservative.  However like anything there are a small number of people that develop sensitivity/allergy to it.   I think the travaprost is drying your eye out overnight. I have had patients with this problem. Often it can be helped as I said:  1. no fan or air blowing in bedroom.  2. put the travaprost in eye 15-20 minutes before bedtime.  3. at bedtime use an overnight lubricant (as a class they are called GEL lubricants  

[bunnings]

thanks l will try the gel lubricant before sleep, what worried be about BAK was what l read that it can damage the eye meshwork possibly making glaucome worse, "An accumulation of BAK has been found in the trabecular meshwork of patients treated chronically (5–10 years) with BAK preserved medications.24 This has led to the hypothesis, yet unproven though, that chronic BAK exposure might worsen glaucoma.1"

[John C Hagan III, MD, FACS, FAAO]

I guess if you look hard enough you can find most anything. I was not aware of that.  I did go an read some of those papers. I don't know what to make of it as if it was proven with certainty that BAK aggravates glaucoma it would not be used as a preservative.  I would expect that preservatives would be found in the trabecular meshwork for patients taking the medicines for years. Whether that is a problem or aggravates glaucoma was not proven by the 2-3 papers I looked at. I suggest you address your concerns to your ophthalmologist

[bunnings]

Would preservative free Tafluprost 0.0015% (Brand name: Saflutan be just as effective or even more effective then Travoprost 0.004% (Brand name: Travatan)? l think l might ask my ophthalmologist about switching

[John C Hagan III, MD, FACS, FAAO]

I could not tell you.  Generally travoprost is considered stronger and longer acting than latanoprost which is the entry product and the most widely prescribed glaucoma drop in the world. Comparative studies are hard to come by partly because people respond differently to the same medication. Your ophthalmologist would be your best source of information.