Clinical Benefits of Preservative-Free Treatment for Glaucoma with a Focus on Preservative-Free Latanoprost

Abstract

Purpose: To highlight the clinical benefits of preservative-free topical therapies in the management of glaucoma, with a focus on preservative-free latanoprost, and their role in improving ocular surface health and long-term treatment outcomes. Methods: A targeted literature search was conducted through May 30, 2024, to identify studies evaluating the efficacy, safety, and patient outcomes associated with preservative-free latanoprost (Monoprost®/Iyuzeh™, Laboratoires Théa, France). Results: Glaucoma is a chronic, progressive disease and the leading cause of irreversible blindness globally, with prevalence expected to rise as the US population ages. Most patients begin with topical eye drops—primarily prostaglandin analogs—to reduce intraocular pressure, often requiring lifelong treatment. However, chronic use of preserved formulations, especially those containing benzalkonium chloride, is associated with ocular surface disease, discomfort, and reduced adherence. Preservative-free topical therapies offer equivalent intraocular pressure-lowering efficacy to preserved alternatives, while significantly improving tolerability, reducing ocular surface disease symptoms, and minimizing conjunctival inflammation that may complicate future surgical interventions. In Europe, preservative-free therapies are well established in treatment guidelines. In the US, preservative-free latanoprost 0.005% (Iyuzeh) was approved in 2022, providing a new option for patients sensitive to preservatives or with coexisting ocular surface conditions. Advancements in multidose preservative-free packaging and sustained-release delivery systems further enhance the potential for improved adherence and long-term disease control. Conclusions: This review highlights the benefits of preservative-free topical glaucoma therapies and includes a targeted review of preservative-free latanoprost 0.005%. Recent technologic advancements including multidose preservative-free delivery systems and sustained-release drug delivery approaches are also discussed.