QUESTION

 

Please read and follow instructions carefully.

Referencing and intext style vancouver

student from UK

Assignment to be Completed:

REQUEST:

Master’s Level Meta-Analysis Project/Coursework (5,000 words) with no less than 40 references, with ZERO plagiarism (please because online submission system will check), for a final year/4th year ‘Masters of Pharmacy Course’.

The project must be written in the style of a Journal

The meta-analysis must especially expand on the attached document titled “Benefits of switching from latanoprost.pdf” which is another meta-analysis. As in, the studies used in that document should be used in the new meta-analysis.

A minimum of 5 studies must be used.

A “Forest plot” MUST be included in the project (the advised software to use is Revman 5.3 [software is free] but using this software not mandatory)

LITERATURE REVIEW:

Before the meta analysis a literature review was completed. You may use the completed literature review as background research if you see fit.

For the literature review, See attached –> “A Metanalysis of preservative toxicity in ophthalmic treatments.docx” document

REFERENCES:

 Vancouver style referencing

No less than 40 references

Any good (non-Wikipedia) references, found on online and offline may be used as long as they relevant or enhance the project in any way.

There are however TWO mandatory references which must be used/referenced in this project.

MANDATORY REFERENCES(NEEDS TO BE INCLUDED) :

See attached –> “Benefits of switching from latanoprost.pdf” file

This PDF contains a Meta analysis of 2 different studies.

It is mandatory/required that these two studies are to be used and expand upon with other studies.

ASSESSMENT CRITERIA:

See attached –> “

Project Report Assessment Form 2018-19.docx” do

This is the assessment criteria. Please refer to this.

Additionally, I was provided with a guideline on how to write a meta-analysis. See attached –> “

META ANALYSIS_2019.pptx” document.

 

Attached Document

Benefits of Switching from Latanoprost

https://drive.google.com/file/d/13a6fyBGDu2yMOrN-bLbs–Ii9EiBQsnv/view?usp=sharing

Project Report Assessment from2018-2019

https://docs.google.com/document/d/14Ll5De8N9dVwUyjEnix0rG93i1u9wFuG/edit?usp=sharing&ouid=116221823243277474442&rtpof=true&sd=true

Meta Analysis 2019

https://docs.google.com/presentation/d/1XXmLM_s2iW4iCNtej5zvNAOk3ug7qmg9/edit?usp=sharing&ouid=116221823243277474442&rtpof=true&sd=true

A Metanalysis of Preservative Toxicity in Ophthalmic Treatment

https://docs.google.com/document/d/1Ibp8j-_C12XzvxklVlQaSKPg3-WDhnuj/edit?usp=sharing&ouid=116221823243277474442&rtpof=true&sd=true

 

ANSWER

BENEFITS OF SWITCHING FROM LATANOPROST TO PRESERVATIVE-FREE TAFLUPROST EYE DROPS: A META-ANALYSIS OF TWO PHASE IIIB CLINICAL TRIALS

Table of Contents

Introduction 

Aims of this study 

Hypothesis 

Methods 

Results 

Discussion 

Conclusion 

Reference list

Introduction

In recent days, the patients of glaucoma frequently suffer from side effects during the treatment along with eye drops of prostaglandin therapy. It is important to focus on the problems of the patients suffer from the complications. It has been observed that various studies have evaluated that huge number of patients suffering from glaucoma by using topical drugs related to concomitant ocular surface disease. The symptoms related to dry eye symptoms are involving the patients to encounter complications. Most importantly, the preservative within the eye drops, mostly benzalkonium chloride (BAC) has the potential to lead the problem of dry eyes and ocular surface disease. Moreover, application of preservative in eye drops can influence a clinical problem in treatment of glaucoma patient. BAC or the preservative can be used with concentrations from the range of 0.004% to 0.02% in the process of glaucoma treatment¹. This can be considered as a toxic in a manner of dose dependent. This preservative has been exposed to have direct toxicity in relation to various tissues based on ocular surface. The adverse effects such as epithelial erosions, conjunctival hyperaemia, punctate keratopathy, and can be caused due to the application of this preservative in eye drops. This study has the aim to evaluate the importance of preservative free eye drops such as tafluprost eye drops rather than preserved latanoprost eye drops. This study is going to discuss the benefits of switching to tafluprost from latanoprost.

It can be mentioned that the issues related to itching, burning, irritation, dry eye sensation, foreign body sensation and tearing can be treated by applying this preservative free eye drops for the patients of glaucoma. The drugs for the glaucoma patients which contain preservative have been incriminated to reduce number of global cells and it can increase the subepithelial collagen deposition. The process of using antiglaucoma drugs and the drugs containing BAC has been linked to lack of success of glaucoma surgery. Tafluprost 0.0015% can be considered as the first ophthalmic solution for the treatment of glaucoma². This type of medication, the ophthalmic solution can be able to help the treatment process for the glaucoma patients. It can be considered as proven clinical intraocular pressure and preclinical efficacy. Along with high selectivity and affinity, Tafluprost can act on prostaglandin receptor of prostanoid. Based on the process of clinical phase 2 IIIb studies, this research is going to recruit some glaucoma patients to analyse the negative impact of preserved latanoprost eye drops. This study has the purpose to effectiveness related to the process of switching over to the preservative free eye drops. Tafluprost. Based on the signs and symptoms of the glaucoma patients, the signs of ocular surface and dry eyes, it is important to evaluate both positive and negative impact of preserved eye drops.

Glaucoma can be considered as a common cause of blindness in the industrial nations along with the prevalences between 1% and 3%³. The study related to ocular hypertension is able to confirm the reduction of 20% in order to response to the treatment of glaucoma⁴. Along with increased efficacy as well as tolerability regarding medications for ocular hypotensive, a new phase of declining glaucoma surgery and glaucoma management. Based on these factors, it can be observed that the rate of survey is evolving. Latanoprost as well as travoprost are considered as ester prodrugs regarding prostaglandin F2α. The free acids in bimatoprost and Travoprost are considered as more potential in the process of activating the receptor related to FP than the free acid within Latanoprost. The concentration of Bimatoprost of 0.03% is for 6 times that of the preserved Latanoprost can allow sufficient conversation to the free acid which can instigate the FP receptor⁵. Latanoprost undergoes the extensive metabolism of first pass metabolism. Moreover, it can be analysed that Latanoprost can be considered as the agents of pressure reducing. Though preserved latanoprost has the side effect to cause dry eye symptom of ocular surface disease, it may be more suitable for CACG patients suffering from systemic disease.

Aims of this study

This study has the aim to investigate the signs and symptoms related to ocular surface disease of patients of glaucoma. It has the aim to evaluate the importance of preservative free eye drops for the patients which can be effective for the disease of ocular surface and the symptoms related to dry eyes. This research project has the aim to analyse the benefits of switching to tafluprost eye drops from preserved latanoprost eye drops. This research has also the aim to apply clinical Phase IIIb study to evaluate the importance of it.

Hypothesis

This research study is able to show some hypothesis in relation to the importance of switch to tafluprost eye drops from latanoprost eye drops. This research can assume the following hypothesis:

H0: Tafluprost eye drops can resolve the issues related to Ocular symptoms of patients of glaucoma

H1: Preserved Latanoprost can be replaced by preservative free eye drops to decrease the signs and symptoms of dry eyes and ocular surface

Methods

Based on this subject matter of the research, this research project is focused on the evaluating the benefits of replacing preserved Latanoprost eye drops by Tafluprost eye drops. In order to analyse the importance of preservative free eye drops, it is important to identify the side effect or symptoms of the glaucoma patients. In this research project, researcher has chosen various journals related based on the approach of using preservative free eye drops. Researcher has chosen the way of Meta analysis to evaluate the efficacy of this analysis. By using 5 journals related to benefits of switching from latanoprost to Tafluprost have been selected to analyse the N to calculate the impact of this project. Based on the methods of data analysis of these five journals, a Forest plot has been used to analyse the data collected from the certain sample size.

In case of this Forest Plan, it is important to measure the weight. This research process based on Forest plot can be effective to analyse the preference or the benefits for the patients. By cultivating the odds ratio, lower confidence and upper confidence of the entire sample population can be measured⁶. Along with the help of the way of systematic review by focusing on Forest plot, researcher can be able to achieve success. The research related to evaluation of the benefits to switch over preservative free eye drops from preserved eye drops for the glaucoma patients has been established on Meta analysis. Through cultivating the process of Meta analysis based on various journals, researcher has conducted the research work⁷. The following results are the evidence based on the method of Meta analysis. The following elements of Forest Plot generator have been presented in this study paper.

Results

According to these studies related to the prevalence of optimal diseases, it can be mentioned that Ocular disease have been expressed in order to influence quality of life and it can cause threat to an individual. This research on this study is able to show that sometimes it can cause serious issues related to mental health. Along with the issues related to glaucoma and blindness, the process of treatment can cause also various other health issues. Basic cause of impaired vision can include cataract, trachoma, glaucoma, these can influence blindness⁸. It has been analysed that it is related to aging population other than eye infections. Based on the current situation, it can be reported that 51% of blindness is responsible throughout the world. Moreover, this increased rate has been predicted to rise due to increase in ageing population. These aspects are considered as prevalent in both developing and developed countries⁹.

The two types of glaucoma, angle closure and open angle glaucoma can be considered as structural as well as functional changes. It can be reported that it can be estimated that it accounts for 4.5 million people blind which is over 12 % among the total number of blindness. Along with the help of this, method of Meta analysis, it has been evaluated that use of preservative free eye drops. Corneal opacities is able to include different infections, inflammation of the eyes as well as it is responsible for about 5.1% blindness as well as it ranked 4th major cause related to blindness¹⁰. The genetic eye diseases are inherited from parents and it seemed to be prevalent in the industrial countries.

It can be reported that Trachoma can result from scarring regarding the cornea and it is as much as 4.9 million people who are affected¹¹. Based on this research project on the benefits of switching from latanoprost to preservative free eye disease, it has been evaluated that the symptoms of dry eye disease and ocular surface disease can be effective to the glaucoma patients¹². Dry eye disease can be caused by many factors as well as it is prevalent in 5% to 34% among the entire population of the world causing irritation as well as visual difficulties¹³.

Table 1: Studies included Meta analysis and application of a Forest Plot

(Source:¹⁴)

The disorder regarding ocular surface can be able to encompass different group of optimal diseases which can lead to changes in the structural component. Based on these common causes it is important to visit ophthalmologists. Various causes regarding ocular surface disease can include genetic factors, meibomian glands and eye infections. Due to using the eye drops with preservatives by the patients of glaucoma, the symptoms of dry eyes and ocular surface disease can be occurred. Apart from these, there are other reasons for ocular surface disease¹⁵. The aspects of eye infections though ophthalmic medications are containing preservations. It can be mentioned that the patients suffer from ocular surface disorder will be able to complain of dry eyes, redness, discomfort, foreign body sensation and light sensitivity¹⁶. Moreover, itching, burning, visual impairment can be caused due to the preservatives within the eye drops¹⁷.

Glaucoma can be considered as the leading cause of blindness in the older population throughout the world as well as it occurs while optic can never get damaged. Due to changes in intraocular pressure caused by build-up of fluid in front of eyes can affect the patients. It can be mentioned that there are some options which can recover the issues related to glaucoma through laser trabeculoplasty or surgery¹⁸. The patients suffering from glaucoma have been using preserved eye drops in order to maintain steady as well as intraocular pressure for the years and they can use two or more medications for antiglaucoma. Apart from these, the patients have frequent checkups for monitoring the treatment and condition. In the process of medication related to glaucoma, use of preservatives in eye drops can cause ocular surface disease which can also fail the surgery of glaucoma filtering.

Figure 1: Graphical presentation of Forest Plot

(Source:¹⁹ )

Based on a study related to medications of glaucoma, it can be analysed that an ocular surface index questionnaire have stated that 40% to 59% of the patients can experience some causes of ocular surface and it can cause the above mentioned symptoms²⁰. However, other studies can suggest active ingredients which could be the cause of damage to the ocular surface.

The preservatives used in the eye drops can be categorized into 4 different types such as oxidative agents, detergents, metabolic inhibitors and chelating agents. In the ophthalmic medications or the eye drops, the following preservatives can be used as most common preservatives. Along with BAC, BAK (detergent) can be used in concentration ranging from 0.004% to 0.05%²¹.

Types of Chemical	Types of Preservative	Eye drops contained preservatives
Quaternary ammonium salts	BAK Polyquarternium-1 PQ1	Timolol Systane Balance (artificial tears)
Phenols	Methylparaben	Gentamicin ointment
Mercurials	Thimerosal	Trifluridine (antiviral)
Alcohols	Chlorbutanol	Tobramycin and dexamethasone combination
Caboxylic acid	Sorbic acid	Diclofenac (NSAIDS)

Table 2: Common preservatives used in eye drops

(Source: ²²)

Along with BAC, Hydroxybenzoate was used in eye drops in the year 1949 due to the activities related to antimicrobial activities and irritation to eyes of an individual. Though the preservatives were introduced in 1963 in British Pharmacopoeia it was discontinued for the reason of corneal damage. The technique regarding to the preservative free system can be able to reduce the risks of causing ocular surface disease and the symptoms of dry eyes²³. As glaucoma requires long term medication or therapy, the group of patients can be able to suffer from more corneal damage. Whereas, the short term therapy, use of preservatives can be considered as safe, based on this reason, the long term process of medication can be suggested for the patients of this disease²⁴. Preservative free medications or treatment for the glaucoma patients are favoured since they can remove the risk factors related to corneal surface and toxicity.

The antimicrobial ac²⁵tivity of BAK of 0.2% in latanoprost can be compared as SofZia in travoprost. The antimicrobial activities of BAK have been tested against different microorganisms. Though the preservatives present in latanoprost can affect the process of treatment of glaucoma patients BAK with latanoprost is more effective to protect the microbes like bacteria and fungi²⁶. The preservatives in ophthalmic statements and the toxicity to preservative free eye drops are able to support the treatment process of glaucoma patients. The clinical trials of phase III studies have adjusted the risks of IOP treatment failure of overall 8%. The percentage of relative IOP reductions from the baseline has been measured through this process of Meta analysis. This Meta analysis based on clinical trials comparing timolol in latanoprost is related to IOP reduction from the baseline of 31.2%²⁷.

In recent days, Prostaglandin analogs is proposed for the treatment of glaucoma patients and the derivatives of prostaglandin F2α such as travoprost, latanoprost as well as bimatoprost are available. In Valk’s Meta analysis, latanoprost is able to reduce IOP by 28% to 33% from the baseline²⁸. Travoprost and latanoprost can be considered as selective prostanoid. The process of binding this FP receptor can exert the IOP lowering effect. All the compounds can decrease IOP by increasing the outflow through unconventional route. In the young individuals, up to near about 30% of aqueous fluid flow²⁹. However, hypotensive lipids have the potential to increase the outflow of aqueous fluid by 50%³⁰. It has been observed that the increased rate in uveoscleral outflow may be caused due to relaxation of ciliary muscle which is leading to widening space between bundles of muscles. It has also been observed that ester forms of PGF derivatives are able to penetrate the cornea much better.

Based on these reasons, all prostanoids except for bimatoprost can be administered as prodrugs. After entering cornea, the prodrugs can be hydrolysed by corneal esteraters to the form of active carboxylic acid. As per the Meta analysis of Uusitalo, the standard deviations for the continuous variables as well as frequencies can be indicated. The demographic characteristics related to this research process have helped to conduct the Meta analysis with the patients of glaucoma separated by age and gender. According to this Meta analysis, only 27 patients discontinued this research prematurely³¹. It has been observed that the most common cause of discontinuation were protocol deviation, request of the patients and adverse event. Moreover, lack of postbaseline data can be considered as other reason of discontinuation. This research is based on a cohort of 339 patients in the sequel.

On the other hand, the present prostaglandin therapy is available in UK which can include bimatoprost of 0.03%, latanoprost of 0.005% as well as travoprost of 0.004%³². Though there is extensive evidence based on efficacy of individual prostaglandin drugs, the comparative effectiveness of these three drugs are sparse. The systematic review based on the Meta analysis of Eyawo and others has the aim to undertake a rigorous review of literature which can identify the process of randomised clinical trials. These trials have the potential to identify randomized trials for evaluating the effectiveness of PGA in treatment of Ocular hypertension and POAG to improve efficacy of drugs³³. As per the process of selecting sample patients, this research has identified the responses through clinical trials by providing Latanoprost or tafluprost can be able to conduct primary outcomes as well as it has the aim to evaluate the impact of IOP lowering. The report of the trials can impact on Conjunctival hyperemia based on the trial process by latanoprost and tafluprost. The importance of powerful drugs and the therapy for the glaucoma patients has helped to conduct this Meta analysis and to establish the significance of the research by clinical trials.

Study 1:Van der Valk et al. 2005	311 (N)
Study 2: Lee et al. 2010	410 (N)
Study 3: Eyawo et al. 2009	1636 (N)
Study 4 Maier et al. 2005	53 (N)
Study 5: Uusitalo et al. 2016	343 (N)
Total	2753
Average	550.6

Table 3: Descriptive statistics and average

(Source:³⁴)

Calculation of variance across studies

Based on the above table, the numeric interpretations are as following:

X̅ (mean sample) = 14

Now, for calculating the centre point,

X₁-X̅= 311-550.6 = -239.6

X₂-X̅= 410-550.6 = -140.6

X₃-X̅= 1636-550.6 = 1085.4

X₄-X̅= 53-550.6 = -497.6

X₅-X̅= 343-550.6 = -207.6

Followed by this, square of the center points are calculated.

(X₁-X̅)² = -57408.16

(X₂-X̅)² = -19768.36

(X₃-X̅)² = 1178093.16

(X₄-X̅ ² = -247605.76

(X₅-X̅)² = -43097.76

Summation of the square roots = 810212.96

Standard variance = 810212.96/ (n-1) = 202553.24

The standards deviance is too large which indicates the data points which are spread out over the wider range of the values. The high rate of standard deviation as per this data analysis can be able to expect a huge number beyond the average. Moreover, it can be analysed that the calculation of standard deviation based on the sample size of the Meta analysis are far beyond from the average rate. This is able to indicate the success of the research project which has supported the value of this research. In relation to this Meta analysis related to the benefits of preservative free eye drops, tafluprost replacing latanoprost, the response of the patients under observations has helped to measure the risks for this project. The high points of standard deviations are able to support the importance of using preservative free eye drops to reduce ocular surface disease and other symptoms of the patients of glaucoma

Discussion

The main purpose of this study is to investigate the tolerability of the glaucoma patients to BAC preserved treatment. Moreover, this study is related to the treatment along with latanoprost which would benefit from switching to preservative free prostaglandin treatment with tafluprost. The method of Meta analysis based on two large phase IIIb clinical trials is able to adopt the protocols of the study. The evidence of BAC is able to induce the toxicity based on ocular surface disease. BAC can be considered as toxic to both mammalian cells and microorganisms³⁵. The process may be associated along with the surface side effect based on variety of eye drops. It can be analysed that the detrimental effect of BAC is accentuated while the eye drops is preserved with the preservatives. In relation to the treatment of glaucoma patients, the emergence of new generation regarding BAC free eye drops and anti glaucoma medications along with negligible concentration is important.

The detergent activities of BAC are able to enhance the effectiveness of the drugs by facilitating the penetration into eyes as well as the process related to delivery to cornea. The results of the Meta analysis have presented the results related to the system related to equal IOP lowering efficacy. Moreover, the efficacy of equal IOP can be demonstrated between the two prostaglandin analogs such as preserved latanoprost and preservative free tafluprost³⁶. The decrease in IOP has been seen along with preservative free tafluprost which can be compared along with preserved latanoprost. Further decrease in IOP was seen with the preservative free tafluprost in order to compare with preserved latanoprost at 12 th week. The alleviation regarding all ocular symptoms as well as signs have been seen after the switch from latanoprost eye drops to preservative free eye drops.

A subset regarding the symptoms and the signs has been reported by a single patient at the baseline regarding the baseline on latanoprost. It can be mentioned that near about 29% to 54% patients did not experience a certain ocular symptom at baseline of latanoprost. By concentrating solely based on the patients with symptoms, the rates of improvements were achieved tafluprost, preservative free eye drops at 12 weeks. The report is able to show that 82% for irritation, 83% for dry eye sensation, 84% for foreign body sensation who were entirely free from these symptoms at the end of 12 week³⁷. The treatment for 12 weeks time period through clinical trial for the sample population of the glaucoma patients have proved the importance of the preservative free eye drops.

The seriousness of conjunctival hyperemia was maintained during the time period of 12 weeks for the treatment of glaucoma patients. The hypermic effect regarding latanoprost may be caused by high concentration of 0.02% of BAC³⁸. There is no clear differences between BAC preserved formulations of both tafluprost and latanoprost were seen for the symptoms of conjunctival hyperemia. Through the process of phase IIIb clinical trial, the patients as well as the response of the patients can be analysed. In relation to these, the hyperemic impact may support the factors to reduce the compliance of treatment³⁹. It can be analysed that these may be a sign regarding conjunctival inflammation and the drug can cause less or no hyperemia. The positive conjunctival epithelial cells, HLA-DR is able to express global cells to study in impression of cytology. The significant changes to the normalisation were seen at the time of treatment with preservative free eye drops. By comparing latanoprost along with preservative free eye drop, tafluprost, researcher has set the goals through the process of Meta analysis to evaluate the importance of switching to tafluprost⁴⁰. The result of this Meta analysis and the Forest plot has exposed that preservative free tafluprost is able to reduce the risk factors and harmful impact on the glaucoma patients. The basic target related to the toxic effect on conjunctiva and other disorders of glaucoma patients regarding the preparations of topical ophthalmic is successful⁴¹.

The superiority of preservative free eye drops, the reports of the patients based on discomfort has reduced substantially during the time period of 12 week. Moreover, apart from the style of clinical trial, QoL questionnaire has helped to show effectiveness of preservative free eye drops. Majority of the patients that is about 72% have preferred preservative free eye drops than BAC preserved latanoprost. The side effect provides decreased effect on treatment procedure related to the research of Meta analysis.

The prostaglandin analogs can be replaced depending on first line therapy of OAG or OH as there are agents of IOP lowering. These systems have helped to support relevant systemic side effect. Tafluprost, the preservative free eye drops can help to reduce the risks of ocular side effects as well as it can increase the likelihood of good treatment. The solution of preservative free eye drops can be beneficial for the patients based on two factors. One is for pre existing ocular surface disease and other is for developing the symptoms of dry eye disease⁴². The solutions can be used in multiple concomitant ocular treatments. The process of conducting this survey is able to help long term medications for surgery of glaucoma patient. The guidelines of glaucoma treatment for the therapies or medications can be maintained and minimise the side effects. Moreover it can be able to increase adherence and it can improve QoL of glaucoma patients. It can be mentioned that a correct choice of first line therapy can be considered as fundamental for achieving the outcome and to reduce economic costs in long run. Preservative free medications or eye drops can provide best option related to monotherapy for the first line treatment of OAG or OH. Costs related to the management process supporting to the desease can be halved if OH is prevented effectively⁴³.

The studies or this Meta analysis related to the benefit of tafluprost, the preservative free eye drops can include an open level design since the availability of BAC preserved latanoprost. Though this research program has not the aim to mitigate the issues related to therapy of glaucoma patients it has evaluated the importance or the source of the symptoms. The patients have identified high values regarding remeasurement even in case of absence related to intervention⁴⁴. A randomised study can be obvious choice which can control the risks related to bias caused by RTM. Moreover, further reduction in IOP with the eye drops free from tafluprost can be attributed for the purpose of improving treatment compliance by better tolerance. However, the 12 week time period for this study did not allow the process of investigation for long term effects of the therapy.

Our research is able to support the fact that the drugs without preservatives in the Meta analysis can be higher than the effectiveness of preserved drugs for the glaucoma patients. The methodological aspects regarding Meta analysis based on clinical trial can be able to support the active participation of the patients in this Meta analysis as sample size⁴⁵. The IOP reductions can be observed by applying preservative free eye drops. In case of this system of Meta analysis, primary indication for the investigated drugs can help to reduce the risk factors of the patients of OAG and OH patients. Through the process of analysing Meta analysis by selecting sample size (N), this research has established the factors which can support the alternative hypothesis by rejecting the null hypothesis⁴⁶. It has been evaluated that the process of medication persistency, the practice focused perspectives can evaluate the long term side effect regarding latanoprost. Lowering IOP can be associated to reduce the rates of glaucoma which is documented by the support of this effectiveness of this study. This study has presented the graphical presentation and the calculation of various variables.

The increased rate is able to induce by preservative free eye drops. Tafluprost can increase optic nerve as well as flow of blood in case of experimental and normal glaucomatous eyes. Along with the process of evaluating the importance of anti glaucoma agents, the observations can be able to suggest that tafluprost can posses an antiapoptotic effect in the cells of retina. The significant changes in the system of visual acuity as well as visual fields can be focused to the system of the treatment of tafluprost which is free from preservatives can impact on majority of the patients who suffer from drop discomfort at the baseline along with latanoprost, the preserved eye drops⁴⁷. The improvement as per the statistical analysis and the numeric data according to the response of the patients has been presented in this report. The frequency distributions regarding the ocular signs can be presented through the Meta analysis regarding the glaucoma patients. The process of analysing the importance of preservative free eye drops not only can impact on the patients suffering from glaucoma but also it can be able to help to develop the treatment aspects of ophthalmological field.

The symptoms of the ocular surface disease can be prevalent at the baseline along with preserved latanoprost. The symptoms related to glaucoma such as irritation, redness, dry eyes, foreign body sensation, itching have been expected to recovered through the process of applying preservative free eye drops. The results as per the provided standard deviations for the variables and the percentages can be evaluated through the demographic characteristics. The observation period of 12 weeks and the data collected based on the experience of the patients have supported the process which can reduce the risk factors of the glaucoma patients. The process of conducting Meta analysis has some strengths and limitations as well. The strengths of this research have supported the extensive searches and the report of primary trial. The outcomes of this research based on phase IIIb clinical trial are able to help to indicate the proper way to analyse the response of the patients⁴⁸. In progression to the blindness, the confirmation related to the drugs can encourage the patients to trust in the treatment process.

Conclusion

This Meta analysis is able to confirm that eye drops free from preservatives can offer clinical benefits to the patients of OAG or OH. This is overweight based on the latanoprost eye drops preserved with BAC. The efficacy of IOP lowering can be sustained after replacing latanoprost by preservative free tafluprost. Moreover, it has been analysed that the signs and symptoms of the glaucoma patients have been resolved by the help of clinical trial using preservative free eye drops. Most importantly the symptoms of ocular surface disease and dry eyes can be resolved by using preservative free eye drops like tafluprost. In the first line therapy on the issues related to ocular hypertension and open angle glaucoma, the importance of powerful drugs can be effective for the patients. The clinicians as well as ophthalmologists are able to choose therapies based on cost associated with certain drugs. The efficacy as well as potential of the preservative free drugs or eye drops can support the process to reduce the risk factors in the treatment of glaucoma patients. The preservative free formulation or solution, tafluprost can be considered as new regimens for the treatment of glaucoma. The anlysis regarding the data from the patients have supported the positive importance of preservative free eye drops. The result of this meta analysis in collaboration to various other journals, it can be analysed that the existing studies related to the benefits of replacing latanoprost by tafluprost, the preservative free eye drops is very promising. The efficacy of the studies, tolerability, and safety related to these new drugs has been established along with the support of the preference of the patients. The impact of this Meta analysis through the process of evaluating the importance of preservative free eye drops rather than preserved latanoprost can be able to support the result of Meta analysis. Based on the set hypothesis for this research, it has been analysed that according to the presence of the patients, the null hypothesis can be rejected and the alternative hypothesis can be accepted.

Reference list

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Baudouin C. Detrimental effect of preservatives in eyedrops: implications for the treatment of glaucoma. Acta Ophthalmologica. 2008;86(7):716-726.

Chandrasekaran S , Cumming RG , Rochtchina E , et al . Associations between elevated intraocular pressure and glaucoma, use of glaucoma medications, and 5-year incident cataract: the Blue Mountains Eye Study. Ophthalmology 2006;113:417–24.doi:10.1016/j.ophtha.2005.10.050

Coroi, Mihaela Cristina et al. “PRESERVATIVES FROM THE EYE DROPS AND THE OCULAR SURFACE” Romanian journal of ophthalmology vol. 59,1 (2015): 2-5.

DesbenoitN , Schmitz-Afonso I , Baudouin C , et al . Localisation and quantification of benzalkonium chloride in eye tissue by TOF-SIMS imaging and liquid chromatography mass spectrometry. Anal Bioanal Chem 2013;405:4039–49.doi:10.1007/s00216-013-6811-7

Egorov EA, Astakhov YuS, Erichev VP, et al. [Evaluation of efficacy and safety of preservative-free tafluprost 0.0015% eye drops in patients with open-angle glaucoma and ocular hypertension]. RMJ Clin Ophthalmol. 2015;16:1–6. Russian

Eyawo O, Nachega J, Lefebvre P, Meyer D, Rachlis B, Lee CW, Kelly S, Mills E. Efficacy and safety of prostaglandin analogues in patients with predominantly primary open-angle glaucoma or ocular hypertension: a meta-analysis. Clinical Ophthalmology (Auckland, NZ). 2009;3:447.

Freeman PD, Kahook MK. Preservatives in topical ophthalmic medications: historical and clinical perspectives. Exp Rev Ophthalmol 2009; 4:59–64. http://www.medscape.com/ viewarticle/588636.

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