Pharmacological treatment of glaucoma is the first step in treating this eye disease. However, medications for glaucoma - in the form of eye drops - are used only after appropriate tests have been performed, when it is certain that the patient has been diagnosed with glaucoma or ocular hypertension, which poses a significant risk of glaucoma and the risk of damage to the optic nerve. Check what the pharmacological treatment of glaucoma is.
At the beginning it should be said that glaucoma cannot be completely cured. All performed treatments are intended only to slow down or completely stop the progressing symptoms. Damage to the optic nerve cannot be undone because the optic nerve cannot regenerate, unlike some tissues in the human body, such as hair, nails, or even the liver. However, it is possible to effectively stop the disease progression so that the patient maintains good vision for the rest of his life. Both the doctor and the patient only need to do the right thing. This is the goal of the doctor treating a patient with glaucoma.
Pharmacological treatment of glaucoma must be preceded by appropriate tests
Of course, the sooner the disease is diagnosed, the greater the chance of successfully stopping its progression. However, the initiation of treatment must always be preceded by a thorough ophthalmological examination of the patient and proper diagnosis. Treatment is only justified if the patient is diagnosed with glaucoma or ocular hypertension, which poses a significant risk of glaucoma and the risk of damage to the optic nerve. It is a mistake to start pharmacological treatment despite the lack of sufficient premises.
Glaucoma - how to recognize?
ImportantThe only effective prophylaxis in glaucoma is regular checkups, with particular emphasis on intraocular pressure testing, tomographic assessment of the optic nerve (HRT), nerve fiber layer (GDx), retinal ganglion cell layer (GCL) and visual field examination (FDT) Matrix / HFA Humphrey). Only if the criteria for the diagnosis of glaucoma or ocular hypertension are met, is the implementation of treatment justified and appropriate. It should be added that the early stage of primary open-angle glaucoma is often difficult to differentiate from the state in which there is only a suspicion of glaucoma, therefore the decisiontreatment must always be individual and preceded by a thorough analysis of test results and an experienced glaucoma specialist's assessment of the risk of optic nerve damage.
Glaucoma - pharmacological treatment of glaucoma
The goal of drug treatment is to lower the intraocular pressure below a value that causes further damage to the optic nerve. If the doctor diagnoses glaucoma, even if the pressure in the eyes is normal, it also aims to lower it. Lowering the intraocular pressure is currently considered the most effective way to stop the progression of glaucoma. The more advanced the glaucoma becomes, the more the eye pressure should be lowered. The first step in proper treatment is the use of anti-glaucoma eye drops.
There are many modern anti-glaucoma medications available today. The most commonly used are:
1. Prostaglandin analogues (latanoprost, tafluprost, travoprost) and prostamides (bimatoprost) 2. Beta receptor antagonists (timolol, levobunolol, Metipranolol, Carteolol, Befunolol, Betaxolol) 3. Carbonic anhydrase inhibitors (Birnzolamide, Dorzolamide) 4. Alpha-2 agonists (Apraclonidine, Brimonidine, Clonidine) 5. Non-selective adrenergic agonists (Epinephrine, Dipivefrin) 6. Parasympathomimetics (Pilocarpine, Carbachol) 7. Osmotic drugs (Glycerol, Isosorbide, Alcohol, Mannitol)
Currently, prostaglandins are considered to be the first-line drugs, i.e. those used at the beginning of treatment. They enable a significant reduction of intraocular pressure even after only one instillation a day, and at the same time show the least systemic side effects. In recent years, many generic drugs have appeared on the market, but the choice of a specific preparation is always made by the prescribing doctor and you must not change it yourself. Drugs from the prostaglandin group quite often cause conjunctival irritation and allergies.
If prostaglandin treatment is insufficient, another drug is added, most often from the group of beta-blockers. These drugs are less likely to cause local irritation, although they may dry out the surface of the cornea. However, they have more systemic side effects resulting from their effects on the cardiovascular and bronchopulmonary systems. If there is a need, the doctor can add another drug, but in this case the patient should most often be referred for additional laser or surgical treatment.
Glaucoma - treatments for glaucoma
About the authorBarbara Polaczek-Krupa, MD, PhD, specialist in eye diseases, Ophthalmology CenterTargowa 2, WarsawDr. Barbara Polaczek-Krupa, MD, initiator and founder of the T2 Center. She specializes in modern diagnostics and treatment of glaucoma - this was also the subject of her PhD thesis defended with honors in 2010.
Dr. med. Polaczek-Krupa has been gaining experience for 22 years, since she started working at the Ophthalmology Clinic of CMKP in Warsaw, with which she was associated in 1994-2014. During this period, she obtained two degrees of specialization in ophthalmology and the title of doctor of medical sciences.
In the years 2002-2016 she worked at the Institute of Glaucoma and Eye Diseases in Warsaw, where she gained knowledge and medical experience by consulting patients from all over Poland and abroad.
For years, as part of cooperation with the Medical Center of Postgraduate Education, he has been a lecturer at courses and trainings for doctors specializing in ophthalmology and primary he alth care.
He is the author or co-author of numerous publications in scientific journals. Member of the Polish Ophthalmology Society (PTO) and the European Glaucoma Society (EGS).