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
Specialty	ophthalmology

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]

• Prostaglandin analogs
• Parasympathomimetic (miotic) agents, including cholinergic and anticholinesterase agents
• Carbonic anhydrase inhibitors (oral and topical)
• Adrenergic antagonists (nonselective and selective Beta1-antagonists)
• Alpha 2 agonists
• Hyperosmotic agents

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

Name	Other names	Mechanism of action	Dosage	IOP decrease	Side effects
Prostaglandin analogs
Latanoprost	Xalatan	Increased USO (uveoscleral outflow )	Once daily	25-32%	pigmentation of eyelashes, eyelid skin pigmentation, hyperemia (red eye), flu-like symptoms (joint/muscle pain and headache)
Bimatoprost	Lumigan	Increased USO (uveoscleral outflow )	Once daily		blurred vision, eyelid redness, eye discomfort, permanently darken iris, darken/thicken eyelashes
Travoprost	Travatan	Increased USO (uveoscleral outflow )	Once daily		blurred vision, eyelid redness, eye discomfort, permanently darken iris, darken/thicken eyelashes
Beta blockers
Timolol	Timoptic	Decrease aqueous production	Every 12 hours	20-30%	bronchospams, bradycardia, depression, impotence
Betaxolol	Betoptic	Decrease aqueous production	Every 12 hours	15-20%	Fewer pulmonary complications due to selective Beta blockage
Adrenergic agents
Brimonidine	Alphagan	Decrease aqueous production, increase USO	every 8–12 hours	20-30%	blurring, foreign body sensation, eyelid edema, dryness, headache, fatigue, hypotension, depression, insomnia
Miotics
Pilocarpine	Isoptocarpine, Pilocar	Increase trabecular outflow	Every 6–12 hours	15-25%	posterior synechia, keratitis, miosis, brow ache, cataract, myopia, retinal tear, dermatitis, increased salivation
Carbonic anhydrase inhibitors
Dorzolamide	Trusopt	Decrease aqueous production	Every 8–12 hours	15-20%	eye irritation, bitter taste
Brinzolamide	Azopt	Decrease aqueous production	Every 8–12 hours	15-20%	eye irritation, bitter taste
Acetazolamide	Diamox	Decrease aqueous production	Every 6–12 hours	15-20%	malaise, depression, weight loss, kidney stones

Combinations

Fotil is a combination drug consisting of:[4]

• Pilocarpine, a parasympathomimetic
• Timolol, a beta-adrenergic receptor antagonist

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. PMC 6768994. PMID 17943780.
4. FASS (drug formulary): Fotil. Retrieved 2015-02-17