VIDEO: COPHy weighs preservative-free glaucoma drops, minimally invasive bleb surgeries

# Preservative-Free Glaucoma Drops vs. MIGS: COPHy Insights

Glaucoma management continues to evolve, with new treatment options offering improved efficacy and patient comfort. At the recent **Congress on Controversies in Ophthalmology (COPHy)**, experts debated the merits of **preservative-free glaucoma drops** versus **minimally invasive glaucoma surgery (MIGS)**. Both approaches aim to lower intraocular pressure (IOP) while minimizing side effects, but which one is right for your patients?

This article explores the key insights from COPHy, comparing the benefits, drawbacks, and ideal use cases for these two leading glaucoma treatments.

## **Understanding Preservative-Free Glaucoma Drops**

Preservative-free glaucoma drops have gained traction as a safer alternative to traditional eye drops containing **benzalkonium chloride (BAK)**, a common preservative linked to ocular surface disease.

### **Benefits of Preservative-Free Drops**
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Reduced ocular surface toxicity: Eliminates BAK, lowering risks of dry eye, irritation, and corneal damage.

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Better long-term compliance: Patients with sensitive eyes are more likely to adhere to treatment.

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Comparable efficacy: Studies show similar IOP-lowering effects to preserved drops.

### **Limitations**
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Higher cost: Often more expensive than preserved formulations.

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Shorter shelf life: Single-dose vials may be less convenient.

## **The Rise of MIGS in Glaucoma Treatment**

MIGS procedures, such as **iStent, Hydrus Microstent, and Xen Gel Stent**, offer a surgical alternative with minimal downtime and fewer complications than traditional glaucoma surgeries.

### **Advantages of MIGS**
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Minimally invasive: Small incisions reduce recovery time and surgical risks.

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Reduced medication burden: Patients may require fewer or no drops post-procedure.

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Effective for mild-moderate glaucoma: Ideal for patients needing better IOP control without aggressive surgery.

### **Challenges of MIGS**
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Not suitable for all glaucoma types: May be less effective in advanced cases.

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Cost and accessibility: Requires specialized training and may not be covered by all insurance plans.

## **COPHy Debate: Drops vs. MIGS**

At COPHy, experts presented compelling arguments for both approaches.

### **Key Arguments for Preservative-Free Drops**
– Non-invasive: No surgical risks, making them ideal for early-stage glaucoma.
– Flexibility: Easily adjusted based on patient response.
– Growing availability: More pharmaceutical companies are investing in preservative-free formulations.

### **Key Arguments for MIGS**
– Long-term cost savings: Reduces reliance on expensive medications over time.
– Better adherence: Eliminates the need for daily drop administration.
– Combination potential: Often performed alongside cataract surgery for added benefit.

## **Patient Selection: Who Benefits Most?**

Choosing between preservative-free drops and MIGS depends on several factors:

### **Ideal Candidates for Preservative-Free Drops**
– Patients with **ocular surface disease** or BAK intolerance.
– Those with **early-stage glaucoma** who respond well to topical therapy.
– Individuals who **prefer non-surgical options**.

### **Ideal Candidates for MIGS**
– Patients with **mild-to-moderate glaucoma** needing better IOP control.
– Those already undergoing **cataract surgery** (combined procedures enhance outcomes).
– Individuals struggling with **medication adherence**.

## **Future Directions in Glaucoma Management**

COPHy highlighted ongoing research in both fields:
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Next-gen preservative-free formulations: Longer-lasting and more affordable options in development.

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Advanced MIGS devices: New stents and implants with improved safety profiles.

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Personalized medicine: Genetic and biomarker-based approaches to tailor treatments.

## **Conclusion: A Balanced Approach**

The debate between **preservative-free glaucoma drops** and **MIGS** underscores the importance of individualized care. While drops remain a cornerstone for early intervention, MIGS offers a compelling alternative for patients seeking long-term solutions with fewer medications.

As research progresses, ophthalmologists must weigh **cost, efficacy, and patient preferences** to optimize glaucoma management. The insights from COPHy reinforce that both treatments have a vital role in preserving vision and improving quality of life.

Stay updated with the latest glaucoma advancements by following **COPHy and leading ophthalmic journals**—because the best treatment is one tailored to your patient’s unique needs.