Preservative-Free Glaucoma Therapy: An Indian Perspective

Published 2026 - 44th Congress of the ESCRS

Reference: POCOR546 | Type: Free paper | DOI: 10.82333/a18h-5151

Authors: Dr Swapna Satyanandan* ¹

¹Medical ,Cipla Ltd,Mumbai ,India

Purpose

Glaucoma is a chronic, progressive optic neuropathy and a leading cause of irreversible blindness. Elevated intraocular pressure (IOP) remains the main modifiable risk factor, and long‑term topical therapy is central to management. However, prolonged exposure to preservatives is associated with ocular surface disease (OSD),presenting as dryness, irritation, burning, or redness. Such symptoms affect comfort, adherence, and overall treatment success. With OSD reported frequently in medically treated glaucoma, preservative‑free (PF) eye drops have emerged as a preferred alternative that maintains IOP control while minimizing ocular surface toxicity. PF formulations may improve tolerability, reduce inflammation, and support long‑term adherence.

Setting

This survey aimed to evaluate real‑world prescribing patterns, clinical perceptions, and decision‑making factors influencing PF therapy use among Indian ophthalmologists. A cross-sectional online survey was conducted from January to September 2025 among 163 ophthalmologists from 84 Indian cities.

Methods

A structured questionnaire captured prescribing behaviours, clinical experience with PF therapy, perceptions of effectiveness and safety and factors influencing treatment decisions. Three responses were excluded from evaluable analysis due to no prior experience with PF formulations, resulting in 160 evaluable responses.

Results

All doctors were aware of PF glaucoma formulations, and 98% had prescribed them. Preexisting OSD in 10–30% of patients was noted by 46%, while 49% reported similar rates of discontinuation due to preservative‑related adverse effects. PF drops were used in 10–30% of patients by 30% of doctors and in 30–50% by 26%, mainly for OSD or multi‑drug therapy. PF was rated superior in efficacy and safety by 55%, and comparable in efficacy but safer by 31%. Most found PF bottles easy to use. Proactive switching was common (74%). Key barriers included cost, limited awareness, and availability. Despite this, many clinicians used PF selectively, citing better safety, adherence, and in some cases improved long‑term IOP control.

Conclusions

The study shows strong awareness and confidence in PF glaucoma formulations, with widespread integration into practice, particularly for patients with OSD or on multiple medications. Many clinicians proactively switch even stable, asymptomatic patients to PF drops to protect the ocular surface long‑term. PF options are viewed as safer, better tolerated, and equally or more effective than preserved drops, with improved adherence commonly reported. Although cost, limited awareness, and availability remain barriers, many still use PF selectively and feel the benefits justify the higher price. Overall, PF therapy is increasingly preferred for long‑term ocular health and sustained disease control.