Medical Treatment of Glaucoma - Chronic Therapies
Primary open-angle
glaucoma (POAG), is the most common form of glaucoma in the United States
with an estimated 2.7 million people affected. The risk of the disease
increases with age and it is the leading cause of blindness in African
Americans, who are three to four times more likely than Caucasians to have
the disease. Open-angle glaucoma develops slowly over time and it
usually affects peripheral vision first, followed by central vision,
and eventual permanent blindness if not treated. Risk factors for glaucoma
include increased intraocular pressure, a family history of the condition,
and high blood pressure. If treated early, it is possible to
slow or stop the progression of the disease.
Key points
- The goal of topical therapies is to preserve visual function by
lowering intraocular pressure (IOP) below a level that is likely to
produce further damage to the optic nerve.
- The growth in available agents for the medical treatment of glaucoma
has increased dramatically over the years.
- It is important to note that no individual medication can be used in
all patients in all circumstances. The goals of therapy are
preserving function with the lowest risk, fewest adverse or undesirable
effects, and least disruption of the patient's life.
- An initial reduction in the intraocular pressure of 20% from
baseline is suggested.
- Patients with more advanced disease on initial presentation
require lower initial reductions to prevent further progression and
vision loss.
- The 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.
- Generic versions of these topical products do not have to prove
bioequivalence or equal effectiveness. Data is generally not available
for guidance on selection.
- Topically administered glaucoma medications can have significant
systemic absorption. Patients must be instructed on the proper
administration techniques to reduce the risk of systemic adverse
effects.
Using this
program
Use the menu below to select information on the various groups of topical
medications including: Prostaglandin analogs, Carbonic anhydrase inhibitors, Adrenergic antagonists (nonselective and selective
Beta1-antagonists), Alpha 2 agonists,
Rho kinase inhibitors, combination products, BAK-free preparations, and
preservative-free options.
The program will provide a list of medications for a particular group, common side effects, and other comments that
help with selection of a particular product. Also check out the estimated
potency option.
References
- Aung T, Chan YH, Chew PT, et al. Degree of angle closure and the
intraocular pressure-lowering effect of latanoprost in subjects with
chronic angle closure glaucoma. Ophthalmology 2005;112:267-71.
- Chabi A, Varma R, Tsai JC, et al. Randomized clinical trial of the
efficacy and safety of preservative-free tafluprost and timolol in
patients with open-angle glaucoma or ocular hypertension. Am J
Ophthalmol 2012;153:1187-96.
- Fingeret M, Gaddie IB, Bloomenstein M. Latanoprostene bunod ophthalmic
solution 0.024%: a new treatment option for open-angle glaucoma and ocular
hypertension. Clin Exp Optom. 2019;102(6):541-550. doi:10.1111/cxo.12853.
https://pubmed.ncbi.nlm.nih.gov/30614563/
- Fraunfelder FT, Bagby GC. Possible hematologic reactions associated
to carbonic anhydrase inhibitors. JAMA 1989;261:2257.
- Fraunfelder FT, Meyer SM. Systemic adverse reactions in glaucoma
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- Katz LJ, Cohen JS, Batoosingh AL, et al. Twelve-month, randomized,
controlled trial of bimatoprost 0.01%, 0.0125%, and 0.03% in patients
with glaucoma or ocular hypertension. Am J Ophthalmol 2010;149:661-71.
- Krupin T, Liebmann JM, Greenfield DS, et al. Low-Pressure Glaucoma
Study Group. A randomized trial of brimonidine versus timolol in
preserving visual function: results from the Low-Pressure Glaucoma
Treatment Study. Am J Ophthalmol 2011;151:671-81.
- Lewis RA, Katz G, Weiss MJ, et al. Travoprost 0.004% with and
without benzalkonium chloride: a comparison of safety and efficacy. J
Glaucoma 2007;16:98-103.
- Li T, Lindsley K, Rouse B, et al. Comparative Effectiveness of First-Line
Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network
Meta-analysis. Ophthalmology. 2016;123(1):129-140.
doi:10.1016/j.ophtha.2015.09.005
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695285/
- Lippa EA, Carlson LE, Ehinger B, et al. Dose-response and duration
of action of dorzolamide, a topical carbonic anhydrase inhibitor. Arch
Ophthalmol 1992;100:495.
- Liu JH, Kripke DF, Weinreb RN. Comparison of the nocturnal effects
of once-daily timolol and latanoprost on intraocular pressure. Am J
Ophthalmol 2004;138:389-95.
- Parrish RK, Palmberg P, Sheu WP, et al. A comparison of latanoprost,
bimatoprost, and travoprost in patients with elevated intraocular
pressure: a 12-week, randomized, masked-evaluator multicenter study. Am
J Ophthalmol 2003;135:688-703.
- Sherwood MB, Craven ER, Chou C, et al. Twice-daily 0.2%
brimonidine-0.5% timolol fixed-combination therapy vs monotherapy with
timolol or brimonidine in patients with glaucoma or ocular hypertension.
Arch Ophthalmol 2006;124:1230-8.
- Strahlman ER, Tipping R, Vogel R. A six-week dose-response study of
the ocular hypotensive effect of dorzolamide with a one-year extension.
Am J Ophthalmol 1996;122:183-94.
- Thygesen J. Glaucoma therapy: preservative-free for all?. Clin
Ophthalmol. 2018;12:707-717. Published 2018 Apr 13.
doi:10.2147/OPTH.S150816
