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

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. 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). 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. 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. Glaucoma is a chronic eye disease that can lead to permanent vision loss if left untreated. It is one of the leading causes of irreversible blindness worldwide. Most people with glaucoma use daily eye drops to reduce intraocular pressure (IOP), which helps protect the optic nerve and preserve vision. However, many of these drops contain preservatives, especially benzalkonium chloride (BAK), which can irritate the eyes and damage the eye's surface over time. Long-term use of BAK-preserved eye drops is linked to a condition called ocular surface disease (OSD). Symptoms of OSD include eye dryness, burning, redness, and blurred vision. These side effects can reduce a person's comfort and make it harder for them to consistently use their medication, leading to worse disease outcomes. Preservative-free (PF) eye drops offer an effective alternative, providing the same IOP-lowering benefits without the harmful effects of preservatives. PF drops have been widely adopted in Europe for many years, with evidence showing improved quality of life for patients and reduced complications related to eye surgery. PF therapies have only recently come to attention in the US, likely because of restricted access due to high costs and limited insurance coverage. This review highlights the advantages of PF eye drops, which include better eye health, fewer side effects, and improved adherence to treatment. It also discusses the recent US approval of PF latanoprost (Iyuzeh) and new technologies for PF drug delivery. PF therapies represent an important shift toward safer, more comfortable long-term glaucoma care.