Glaucoma medication

The goal of currently available glaucoma therapy is to preserve visual function by lowering intraocular pressure (IOP) below a level that is likely to produce further damage to the nerve. The treatment regimen that achieves the goal of preserving function with the lowest risk, fewest adverse effects, and least disruption of the patient's life, taking into account the cost implications of treatment, should be the approach taken.

Glaucoma medication
Latanoprost
Specialtyophthalmology

The more advanced the glaucomatous process on initial presentation, the lower the target range generally needs to be to prevent further progression. This more aggressive target is meant to minimize the risk of progressive glaucoma damage and vision loss. Once the optic nerve is damaged, it is more likely to incur more damage, and if severe visual loss is present, there is greater impact on the patient from any additional damage that may occur.

An initial reduction in the intraocular pressure of 20% from baseline is suggested. However, reduction of IOP to the target pressure range does not guarantee that progression will not occur. Therefore, the target pressure range needs to be constantly reassessed and changed as dictated by IOP fluctuations, optic nerve changes, and/or visual field progression.

Medical uses

Medications are divided into several groups based on chemical structure and pharmacologic action. Agents in common clinical use include:[1][2]

When comparing people with primary open-angle glaucoma and ocular hypertension, medical intraocular pressure lowering treatment slowed down the progression of visual field loss.[3]

Comparison table
NameOther namesMechanism of actionDosageIOP decreaseSide effects
Prostaglandin analogs
LatanoprostXalatanIncreased USO (uveoscleral outflow )Once daily25-32%pigmentation of eyelashes, eyelid skin pigmentation, hyperemia (red eye), flu-like symptoms (joint/muscle pain and headache)
BimatoprostLumiganIncreased USO (uveoscleral outflow )Once dailyblurred vision, eyelid redness, eye discomfort, permanently darken iris, darken/thicken eyelashes
TravoprostTravatanIncreased USO (uveoscleral outflow )Once dailyblurred vision, eyelid redness, eye discomfort, permanently darken iris, darken/thicken eyelashes
Beta blockers
TimololTimopticDecrease aqueous productionEvery 12 hours20-30%bronchospams, bradycardia, depression, impotence
BetaxololBetopticDecrease aqueous productionEvery 12 hours15-20%Fewer pulmonary complications due to selective Beta blockage
Adrenergic agents
BrimonidineAlphaganDecrease aqueous production, increase USOevery 8–12 hours20-30%blurring, foreign body sensation, eyelid edema, dryness, headache, fatigue, hypotension, depression, insomnia
Miotics
PilocarpineIsoptocarpine, PilocarIncrease trabecular outflowEvery 6–12 hours15-25%posterior synechia, keratitis, miosis, brow ache, cataract, myopia, retinal tear, dermatitis, increased salivation
Carbonic anhydrase inhibitors
DorzolamideTrusoptDecrease aqueous productionEvery 8–12 hours15-20%eye irritation, bitter taste
BrinzolamideAzoptDecrease aqueous productionEvery 8–12 hours15-20%eye irritation, bitter taste
AcetazolamideDiamoxDecrease aqueous productionEvery 6–12 hours15-20%malaise, depression, weight loss, kidney stones

Combinations

Fotil is a combination drug consisting of:[4]

See also

References
  1. Basic and clinical science course (2011–2012). Glaucoma. American Academy of Ophthalmology. ISBN 978-1615251179.
  2. Myron Yanoff; Jay S. Duker (2009). Ophthalmology (3rd ed.). Mosby Elsevier. ISBN 9780323043328.
  3. Vass, C.; Hirn, C.; Sycha, T.; Findl, O.; Bauer, P.; Schmetterer, L. (2007-10-17). "Medical interventions for primary open angle glaucoma and ocular hypertension". The Cochrane Database of Systematic Reviews (4): CD003167. doi:10.1002/14651858.CD003167.pub3. ISSN 1469-493X. PMID 17943780.
  4. FASS (drug formulary): Fotil. Retrieved 2015-02-17
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