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{{Short description|Eye condition 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 this goal 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 one employed.
{{Infobox medical intervention
| name = Glaucoma medication
| synonym =
| image = Pfizer xalaTAN latanoprost eye drops.jpg
| caption = Latanoprost
| alt =
| pronounce =
| specialty = Ophthalmology
| synonyms =
| ICD10 =
| ICD9 =
| ICD9unlinked =
| CPT =
| MeshID =
| LOINC =
| other_codes =
| MedlinePlus =
| eMedicine =
}}


'''Glaucoma medication''' is divided into groups based on chemical structure and pharmacologic action. The goal of currently available [[glaucoma]] therapy is to preserve visual function by lowering [[intraocular pressure]] (IOP) in patients that have an increased intraocular pressure.
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.


== Medical uses ==
An initial reduction in the IOP 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.
Agents in common clinical use include:<ref name="ao" /><ref name="yanoff" />


⚫
* Prostaglandin analogs
Medications are divided into several groups based on chemical structure and pharmacologic action. The groups of agents in common clinical use include<ref name=ao /> <ref name=yanoff /> :
⚫
* [[Parasympathomimetic drug|Parasympathomimetic (miotic) agents]], including cholinergic and anticholinesterase agents
⚫
* [[Carbonic anhydrase inhibitor]]s (oral and topical)
⚫
* Adrenergic antagonists (nonselective and selective Beta1-antagonists)
* [[Alpha-2 agonist|Alpha 2 agonists]]
⚫
* Hyperosmotic agents
* Nitric oxide donators<ref>{{cite web | url=https://encyclopedia.pub/entry/17197 | title=Nitric Oxide-Donating Drugs for IOP Lowering }}</ref>
* [[Rho_kinase_inhibitor|Rho kinase inhibitors]]


When comparing people with primary open-angle glaucoma and ocular hypertension, medical intraocular pressure lowering treatment slowed down the progression of visual field loss.<ref>{{Cite journal|last1=Vass|first1=C.|last2=Hirn|first2=C.|last3=Sycha|first3=T.|last4=Findl|first4=O.|last5=Bauer|first5=P.|last6=Schmetterer|first6=L.|date=2007-10-17|title=Medical interventions for primary open angle glaucoma and ocular hypertension|journal=The Cochrane Database of Systematic Reviews|volume=2007 |issue=4|pages=CD003167|doi=10.1002/14651858.CD003167.pub3|issn=1469-493X|pmid=17943780|pmc=6768994}}</ref>
⚫
* prostaglandin analogs
⚫
* Adrenergic antagonists (nonselective and selective)
⚫
* Parasympathomimetic (miotic) agents, including cholinergic and anticholinesterase agents
⚫
* Carbonic anhydrase inhibitors (oral and topical)
* Adrenergic agonists (nonselective and selective Beta2-agonists)
⚫
* hyperosmotic agents


==Comparison table==
{| class="wikitable"
{| class="wikitable"
|-
|-
Line 20: Line 43:
|colspan="6" style="text-align: left;" bgcolor="khaki"| '''Prostaglandin analogs'''
|colspan="6" style="text-align: left;" bgcolor="khaki"| '''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)
| [[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
|-
|-
|colspan="6" style="text-align: left;" bgcolor="khaki"| '''Beta blockers'''
|colspan="6" style="text-align: left;" bgcolor="khaki"| '''Beta blockers'''
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|colspan="6" style="text-align: left;" bgcolor="khaki"| '''Adrenergic agents'''
|colspan="6" style="text-align: left;" bgcolor="khaki"| '''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
|[[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
|-
|-
|colspan="6" style="text-align: left;" bgcolor="khaki"| '''Miotics'''
|colspan="6" style="text-align: left;" bgcolor="khaki"| '''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
|[[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
|-
|-
|colspan="6" style="text-align: left;" bgcolor="khaki"| '''Carbonic anhydrase inhibitors'''
|colspan="6" style="text-align: left;" bgcolor="khaki"| '''Carbonic anhydrase inhibitors'''
|-
|-
|[[Dorzolamide]]||Trusopt||Decrease aqueous production||Every 8-12 hours||15-20%||eye irritation, bitter taste
|[[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
|[[Brinzolamide]]|| Azopt||Decrease aqueous production||Every 8–12 hours||15-20%||eye irritation, bitter taste
|-
|-
|[[Acetazolamide]]||Diamox||Decrease aqueous production||62.5-250mg/every 6-12 hours||15-20%||malaise, depression, weight loss, kidney stones
|[[Acetazolamide]]||Diamox||Decrease aqueous production||Every 6–12 hours||15-20%||malaise, depression, weight loss, kidney stones
|-
|-
|}
|}


==See also==
==Combinations==
{{anchor|Pilocarpine/timolol}} Fotil is a [[combination drug]] consisting of:<ref>[[FASS (drug formulary)]]: [http://www.fass.se/LIF/product?userType=2&nplId=19920918000016 Fotil]. Retrieved 2015-02-17</ref>
* [[Glaucoma]]
*[[Pilocarpine]], a [[parasympathomimetic]]
*[[Timolol]], a [[beta-adrenergic receptor antagonist]]


==References==
==References==


{{Reflist|refs=
{{Reflist|refs=
<ref name=ao>{{cite book|last=Basic and clinical science course|title=Glaucoma|year=2011-2012|publisher=American Academy of Ophthalmology|isbn=978-1615251179}}</ref>
<ref name=ao>{{cite book|last=Basic and clinical science course|title=Glaucoma|year=2011–2012|publisher=American Academy of Ophthalmology|isbn=978-1615251179}}</ref>
<ref name=yanoff>{{cite book|last=Myron Yanoff, Jay S. Duker|title=Ophthalmology|year=2009|publisher=Mosby Elsevier|isbn=9780323043328|edition=3rd ed.}}</ref>
<ref name=yanoff>{{cite book|author1=Myron Yanoff |author2=Jay S. Duker |title=Ophthalmology|year=2009|publisher=Mosby Elsevier|isbn=9780323043328|edition=3rd}}</ref>
}}
}}


Latest revision as of 12:24, 14 July 2024

Glaucoma medication
Latanoprost
SpecialtyOphthalmology

Glaucoma medication is divided into groups based on chemical structure and pharmacologic action. The goal of currently available glaucoma therapy is to preserve visual function by lowering intraocular pressure (IOP) in patients that have an increased intraocular pressure.

Medical uses

[edit]

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.[4]

Comparison table

[edit]
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

[edit]

Fotil is a combination drug consisting of:[5]

References

[edit]
  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. ^ "Nitric Oxide-Donating Drugs for IOP Lowering".
  4. ^ 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. 2007 (4): CD003167. doi:10.1002/14651858.CD003167.pub3. ISSN 1469-493X. PMC 6768994. PMID 17943780.
  5. ^ FASS (drug formulary): Fotil. Retrieved 2015-02-17
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