Treatment of Glaucoma

Glaucoma Medications

Many times, eye medications are used in the beginning to treat glaucoma or ocular hypertension where the eye pressure is too high. One of the problems with glaucoma medications is compliance by the patient. Since glaucoma does not give any symptoms in the beginning, many patients tend to become less compliant with using their medications over time. It is very important that glaucoma patients use their medications correctly. Any vision loss or glaucoma damage is permanent.

Timoptic

These are non-selective beta-adrenergic receptor blockers. The medication is believed to slow down the production of aqueous humor in the eye and decreases the eye pressure.

Side Effects

You should not use this medication if you have asthma, COPD, bradycardia, heart block, and/or congestive heart failure. Make sure you tell the eye doctor about all the medications you take and give thorough medical history. This medicine should be used with caution in people significant allergy problems and diabetes.

Dosage and Administration

Timolol or Timoptic is approved for the treatment of open angle glaucoma or ocular hypertension. The medication is usually prescribed as 1 drop in the eye once or twice a day.

Betoptic 0.5% and Betoptic S 0.25% (Betaxolol hydrochloride)

Betoptic is a cardioselective beta-adrenergic receptor inhibitor approved for the treatment of glaucoma. It is different from other beta blockers used in glaucoma that it does not have an effect on the receptors in the lungs. It can be used in people with a history of asthma and COPD. Just like other beta blockers, Betoptic is believed to lower the eye pressure by reducing the amount of fluid produced inside the eye.

Side Effects

Contraindications

Dosage and Administration

Betoptic is supplied in 10 and 15 mL eye drop dispenser bottles. The dosage is one drop in the affected eye two times a day.

Xalatan, Xalatan PF (preservative free), or Latanoprost (generic)

Latanoprost is a proteinoid selective FP receptor agonist. It is believed that latanoprost’s mechanism of action is reduce the eye pressure by increasing the outflow of the fluid inside the eye. Latanoprost begins to work in about 3 to 4 hours after instillation and has its maximum effect at 8 to 12 hours. The eye pressure reduction lasts for 24 hours.

Side Effects

Dosage and Administration

Latanoprost 0.005% is a clear sterile liquid which is supplied in a 2.5mL eye drop dispenser. Latanoprost is indicated for the treatment of open angle glaucoma or ocular hyper tension. Any extra bottles not being used should be stored in a refrigerator. Contact lenses should not be inserted until 15 minutes after instillation. Latanoprost causes increased pigmentation of the iris. Blue eyed individuals typically do not see any increased pigmentation. The dosage of Latanoprost is 1 drop in the eye at bedtime.

Lumigan

Lumigan (bimatoprost ophthalmic solution) 0.01% is a synthetic prostamide analog that reduces the eye pressure. Lumigan is indicated in the treatment of glaucoma or ocular hypertension. Lumigan is believed to lower the eye pressure by increasing the outflow of aqueous humor through the trabecular meshwork and uveoscleral pathways.

Side Effects

Increased thickness and length of eye lashes (Latisse is the brand name for Lumigan used to increase the thickness and length of eye lashes applied to the eyelash area of the lids).

Dosage and Administration

Lumigan is indicted in the treatment of open angle glaucoma or ocular hyper tension. The reduction of eye pressure begins approximately 4 hours after instillation with the maximum effect at 10 to 12 hours. Lumigan is administered in the affected eye or eyes once daily at bedtime or evening. It has been found that more frequent administration may decrease the eye pressure lower effect of the drug. Lumigan is supplied in a sterile eye drop dispenser with a turquoise bottle cap in 2.5mL, 5mL, and 7.5 mL sizes.

Travatan Z

Travatan Z (travoprost ophthalmic solution) 0.004% is a synthetic prostaglandin F analogue. Travatan Z is approved for the treatment of open angle glaucoma and ocular hypertension. Travatan Z is believed to lower the eye pressure by increasing the outflow of aqueous humor through uveoscleral tract and trabecular meshwork.

Side Effects

Travatan Z may cause somewhat less irritation as it has less chemical preservatives.

Dosage and Administration

Travatan Z is instilled into the affected eye or eyes once daily at bedtime or evening. The reduction of eye pressure begins within 2 hours and reaches its maximum effect at 12 hours. Travatan Z is supplied in a sterile eye drop dispensing bottle in 2.5 mL and 5 mL sizes.

Alphagan P or Brimonidine (generic)

Alphagan P (brimonidine tartrate ophthalmic solution) 0.1% and 0.15% is an alpha-adrenergic receptor agonist. It is a relatively selective alpha-2 adrenergic receptor agonist. Brimonidine is felt to have a dual mechanism of action by reducing aqueous humor production and increasing uveoscleral outflow. It is indicated for the treatment of open angle glaucoma and ocular hypertension.

Side Effects

Allergic conjunctivitis, conjunctival redness, and eye pruritus or itching
Burning sensation
Visual disturbance
Bradycardia
Fatigue
Flu symptoms

Headache
Depression
Miosis or small pupil
Hypotension
Itchy eyes
Respiratory depression
Dry mouth

Dosage and Administration

Alphagan P is supplied in sterile eye drop dispensers with purple tops in sizes of 5 mL, 10 mL, and 15 mL amounts and two strengths of 0.1% and 0.15%. The generic version comes in a 0.2% solution. The recommended dosage is one drop in the affected eye or eyes three times a day. Many times, eye doctors have their patients use the medication two times a day. Many patients fail to use the medication three times a day and may stop the medicine all together if they become frustrated with the three time a day dosage. Alphagan P reaches its maximum effect within 2.5 hours after instillation and fairly rapidly decreases in the eye tissue.

Combigan (brimonidine tartrate/timolol maleate solution) 0.2%/0.5%

Combigan is the combination of brimonidine and timolol in one bottle. Combigan is indicated in the treatment of open angle glaucoma and/or ocular hypertension. Combigan lowers the eye pressure by decreasing the production of fluid inside the eye and increasing uveoscleral outflow of aqueous humor from the eye. Peak concentration for brimonidine is 1 to 4 hours after instillation and 1 to 3 hours for timolol after instillation.

Side Effects

Allergic conjunctivitis, conjunctival redness, and eye itching
Burning sensation
Visual disturbance
Bradycardia
Fatigue
Flu symptoms
Headache
Hypotension
Itchy eyes
Respiratory depression

Dry mouth
Redness
Irritation
Depression
Erectile dysfunction
Wheezing or difficulty breathing
Swelling
Decreased heart rate
Blurred vision
Stinging on instillation

Dosage and Administration

Combigan is supplied in sterile eye drop dispensing bottles with a blue top. It is supplied in:

The dosage is 1 drop in the affected eye or eyes two times a day approximately 12 hours apart.

Trusopt or Dorzolamide (generic) or Azopt

Trusopt (dorzolamide hydrochloride ophthalmic solution) 2% is a carbonic anhydrase II inhibitor. Inhibition of carbonic anhydrase in the ciliary body (located behind the iris and is responsible for the production of the aqueous humor inside the eye) decreases the aqueous humor secretion resulting in a lower of the intraocular pressure. Dorzolamide has been shown to lower the eye pressure by 3 to 5 mmHg.

Warning and Precautions

Dorzolamide contains a sulfonamide in its chemical makeup and should not be used in anyone allergic sulfa compounds.

Side Effects

Dosage and Administration

Dorzolamide is supplied in white eye drop bottles. It is supplied in:

The recommended dosage of dorzolamide is 1 drop in the affected eye 3 times a day. Most eye doctors prescribe its use as 2 times a day. If this gives the desired results then the 3^rd drop is not needed.

Cosopt, Cosopt PF or Dorzolamide/Timolol (generic)

Cosopt is a combination of a carbonic anhydrase inhibitor and a beta-adrenergic receptor blocking medication. It combines dorzolamide and Timolol in 1 bottle.

Side Effects

Bitter taste in mouth
Superficial punctuate keratitis
Conjunctivitis
Blurred vision
Eye redness
Tearing
Dryness
Photophobia or light sensitivity
Dry mouth
Contact dermatitis

Redness
Irritation
Depression
Ocular inflammation
Erectile dysfunction
Wheezing or difficulty breathing
Swelling
Decreased heart rate
Blurred vision
Stinging on instillatio

Dosage and Administration

Cosopt PF is preservative free and is supplied in:

Cosopt and Dorzolamide/Timolol is supplied in a white eye drop bottle with a white cap and is supplied in:

The recommended dosage is 1 drop in the affected eye or eyes 2 times a day.

Simbrinza (brinzolamide/brimonidine tartrate ophthalmic solution) 1%/0.2%

Simbrinza is a combination of an anhydrase inhibitor (brinzolamide) and an alpha 2 adrenergic receptor agonist (brimonidine) indicated for the reduction of intraocular pressure. It has the same mechanism of action as dorzolamide and brimonidine previously discussed.

Side Effects

Bitter taste in mouth
Superficial punctuate keratitis
Conjunctivitis
Blurred vision
Eye redness
Tearing
Dryness
Photophobia or light sensitivity
Dry mouth
Contact dermatitis
Allergic conjunctivitis, conjunctival redness, and eye pruritus or itchin

Burning sensation
Visual disturbance
Bradycardia
Fatigue
Flu symptoms
Headache
Depression
Miosis or small pupil
Hypotension
Itchy eyes
Respiratory depression
Dry mouth

Dosage and Administration

Simbrinza is supplied in white eye drop bottles with a light green cap and is supplied in:

Diamox (acetazolamide)

Diamox is a carbonic anhydrase inhibitor for oral administration for the reduction of eye pressure. Diamox is a strong carbonic anhydrase inhibitor which controls fluid secretion used in glaucoma, treatment of certain cases of epilepsy, other instances of fluid retention, and altitude sickness.

Contraindications

Diamox is contraindicated in patients with sodium/potassium blood serum level are depressed, in hyperchloremic acidosis, kidney and liver disease, and in suprarenal gland failure. Since Diamox is a sulfonamide derivative, it should be used with caution in people allergic to sulfa.

Side Effects

Dosage and Administration

Diamox is supplied as:

Vyzulta (latanoprostene bunod ophthalmic solution) 0.024%

Vyzulta is a prostaglandin analog indicated for the reduction of eye pressure in open-angle glaucoma patients. The reduction of eye pressure begins 1 to 3 hours after instillation and reaches maximum effect at 11 to 13 hours after instillation. Vyzulta is thought to lower eye pressure by increasing outflow from the eye through the trabecular meshwork and uveoscleral route.

Side Effects

Dosage and Administration

Vyzulta is supplied in 7.5mL eye drop dispensing bottle with a turquoise cap with 5 ml of medicine.

Vyzulta is used 1 drop in the evening.

Rhopressa (netarsudil ophthalmic solution) 0.2%

Rhopressa is a RHO kinase inhibitor indicated for the reduction of eye pressure in patients with open-angle glaucoma. Rhopressa is thought to work in the trabecular meshwork by improving outflow of fluid from the eye.

Side Effects

Dosage and Administration

Rhopressa is supplied in white opaque eye drop bottles with a white cap with 2.5 ml in a 4 mL bottle.

Rhopressa is prescribed as 1 drop in affected eye or eyes in the evening.

JAMES E. CROLEY III, M.D.

Dr. James E. Croley III is a board-certified ophthalmologist and the founder of the Cataract & Refractive Institute of Florida. He graduated magna cum laude from Cumberland College before attending medical school at the University of Miami and completing his residency at the University of Alabama Eye Foundation Hospital. Additionally, he studied at Stanford University where he gained further education in advanced ophthalmology techniques. Dr. Croley is a member of the American Academy of Ophthalmology and the Florida Society of Ophthalmology.