Preservative-free glaucoma eye drops; some are available but not funded

Information provided by Dr Hannah Kersten

According to the NZ Formulary, there are currently three preservative free glaucoma preparations available in New Zealand:

  • Bimatoprost preservative free – not funded
  • Ganfort preservative free – not funded
  • Timolol 0.25% and 0.5% preservative free – not funded*

*Section 29 – able to be prescribed by medical professionals only (ie. not optometrists)

Unfortunately, none of them are funded. The preserved versions of bimatoprost and timolol are funded, but Ganfort (which is a combination of bimatoprost and timolol) is not funded, even in the preserved form.

I have not included Pilocarpine nitrate 2% in this list, as even though it falls under the umbrella of glaucoma treatment, and is available funded and preservative free. The medication is very rarely prescribed as it is not as effective as some other medication categories, and comes with more potential adverse effects.

In the UK, for example, there are many options for funded preservative free drops.

Long term treatment with preserved eye drops, in a chronic condition such as glaucoma, can lead to inflammation of the eyelids and ocular surface, resulting in blepharitis and dry eye.

These conditions are very common in the general population, but even more prevalent among patients with glaucoma. If the patient already has eyelid or ocular surface inflammation, preservatives can further aggravate this.

For patients, symptoms experienced can include burning, itching, redness, irritation and watery eyes. If the inflammation is more severe, the disruption of the ocular surface and tears can also cause reduced vision.

Patients with blepharitis and dry eye often require other treatments, which can add to a sometimes already burdensome treatment load, impacting patient quality of life. This in turn can affect patient adherence to prescribed treatment regimens and can increase the likelihood of permanent vision loss from glaucoma.

Anecdotally, a number of patients come to us, having researched online, requesting preservative free eye drops and we then have to explain to them that they are unfortunately not funded in New Zealand, despite being widely available elsewhere.

Dr Hannah Kersten is a therapeutic optometrist with a particular interest in glaucoma and neuro-ophthalmic disorders. A trustee of GNZ, she currently holds clinical and research roles at Eye Institute in Auckland.

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