The Preservative Freedom Coalition (PFC), which was founded by The Glaucoma Foundation, The Intrepid Eye Society, National Medical Association Ophthalmology Section, Real World Ophthalmology and Thea, said in a statement that it is pleased to see increasing attention on preservatives in treatment and more consideration around the impact of preservative load gaining greater focus. 

Recently, the American Optometric Association (AOA) called for feedback on the proposed guidelines for its Evidence-Based Clinical Practice Guideline for care of the patient with Primary Open-Angle Glaucoma, which is designed to provide optometrists and industry professionals with the best examination and treatment protocols for primary open-angle glaucoma (POAG). The guide covers timely diagnosis, treatment options, patient education and referrals. 

PFC said in the statement that it supports and commends the AOA in continuing to build clarity around the treatment of POAG. In the draft for feedback, PFC said it was encouraging to see information and recommendations around preservatives in treatments. 

“Given the considerable evidence on the impact of preservatives on short- and long-term ocular health, and the increasing choice for preservative-free options, we believe that there is room for guidance and greater depth of information on how preservative-free medications should be incorporated into treatment,” the coalition said in the statement. 

The PFC’s suggested revisions highlight the availability and benefits of preservative-free treatments. In their feedback, PFC suggested:

• Inclusion of classes of medications with preservative-free options for greater awareness and visibility of available options
• Additional information on the impact of preservative-related side-effects on treatment adherence, patient comfort and long-term care management 
• Suggestion specifically around switching to BAK-free formulas when possible
• The importance of dialogue around preservative-free treatment options during patient consultations to encourage patients' knowledge on the various available preservative-free options 

Preservative-free drops have been shown to reduce side effects in patients who experience discomfort from current preserved glaucoma medications, the PFC stated. Preservative-free drops also reduce the long-term toxic effects on the trabecular meshwork and subsequent impact on surgical outcomes. Therefore, the PFC said, preservative-free options should be included in treatment conversations between patients and doctors because of their immediate and long-term benefits to ocular health and patients' quality of life. 

"Choosing preservative-free options, where possible, has immediate and long-term benefits to preserving ocular surface health. Having strong guidelines that support the use of preservative-free options will help build an environment that improves education on preservatives and will help break down barriers to access," the PFC concluded.