Glaucoma - Diagnosis

Treatment

Glaucoma cannot be cured, but treatment may help delay disease progression. Most treatments for glaucoma aim to reduce ocular pressure and its fluctuations. Early treatment with medications, surgery, or both can nearly always maintain safe pressure of the aqueous humor, thus preventing optic nerve damage and blindness.

Decision to Start Treatment

Many people have high IOP but no sign of nerve damage. Over the course of 20 years, only 10 - 30% of these people will actually develop glaucoma. Nevertheless, once glaucoma has destroyed optic nerve fibers, no treatment can reverse the damage.

However, not all individuals with warnings for glaucoma (elevated IOP) develop optic nerve damage and serious vision problems. Nor does treatment prevent progression in some patients. Medications used for glaucoma also can carry side effects and risks.

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Some doctors recommend delaying treatment for people with borderline or early signs of glaucoma until they begin to show risk factors for progressive disease and vision loss (thinner corneas, larger cup to optic disc ratio, older age, and rising pressure).

Considerations for Drug Treatments

A number of drugs are available to treat glaucoma. The drugs reduce pressure in the eye but all have a number of side effects that affect other parts of the body. Occasionally, some side effects can be severe. Many of the drugs used for glaucoma also interact with common medications for other conditions. To compound the difficulties, many patients require multiple drugs. As a result, only about half of patients comply with their treatments.

Doctors generally first recommend topical drugs (such as eye drops or ointments).

• Topical beta-blockers are the standard first-line drugs, most commonly timolol (Timoptic). Newer beta-blockers include betaxolol (Betoptic), levobunolol (Betagan), carteolol (Ocupress), and metipranolol (OptiPranolol). Timolol has been used for years, and these other drugs are also well tolerated.
• Topical prostaglandins are alternatives if beta-blockers fail. They include latanoprost (Xalatan) and unoprostone (Rescula). Of the standard drugs used for glaucoma, these drugs have the greatest effect on lowering IOPs. They also have fewer widespread effects than beta-blockers.
• Topical carbonic anhydrase inhibitors (CAIs) are less effective than standard beta-blockers or prostaglandins but have fewer widespread effects than the beta-blockers. They may be helpful in certain cases. Topical forms are dorzolamide (Trusopt) and brinzolamide (Azopt). (Oral CAIs are available and more effective, but they have severe side effects and are rarely used for the long term.)
• Alpha2-adrenergics, also called selective alpha adrenergics, are effective but may not be as well tolerated as timolol. They include brimonidine (Alphagan).
• Miotics, which include pilocarpine and others, were the standard drugs before the introduction of topical beta-blockers. They have now been largely replaced by timolol and others, although they are sometimes used in combination with other drugs.