Glaucoma Medical Treatment

The goal of treatment in glaucoma is to preserve the patient’s vision for as long as possible with the least detrimental effect on the patient’s quality of life. At present, the only available treatment to prevent glaucoma progression is to lower the intraocular pressure (IOP).

The most commonly used method of lowering IOP in glaucoma patients is by using medications, particularly eye drops. One or more eye drops may be needed. There are many IOP-lowering eye drops available and the ophthalmologist will choose the most appropriate one/s. Using eye drops rather than oral medications has the following advantages: ease of use, less systemic side effects, and improved efficacy because the drug is delivered directly where it is needed.

Different eye drops each have their own side effects. Some of these side effects are local, meaning they only affect the area where they were placed. Others are systemic, meaning they affect distant parts of the body. Your doctor will tell you about what side effects to expect and which ones to watch out for depending on what drops have been prescribed.

Different dose regimens are needed for different eye drops. Some drops are used only once a day while others need to be placed twice a day or more often. You doctor will tell you how often to place the drop/s you have been prescribed. Do not place the drops more frequently than prescribed because this will not improve the efficacy of the drug and will only increase the chances of a bad reaction to the drug.

It is important that the eye drops go where they belong – in the eye, not on the eyelid, eyelashes, or cheek. The proper technique of instilling eye drops is described here.

1. Continuity of treatment is very important. Missing even just one dose can cause an IOP spike that could be harmful especially in those with advanced glaucoma. Some tips to avoid missing a dose are listed below:
2. Link the placing of drops with an activity you perform every day at approximately the same time. For example, if you take a shower every morning at around the same time then you could make it your habit to place your drops after your morning shower.
3. Many modern conveniences are available that can help you remember when it’s time to put in your drops. For example, you can use your mobile phone’s alarm feature.
4. Buy your next bottle before the current one runs out.

Let your doctor know if you experience side effects that are bad enough to make you want to stop using the drops. Don’t just stop the drops on your own.

Some eye drops, not just glaucoma eye drops, can have side effects on the other organs of the body. To prevent this it is important to close the eyes and press on the tear ducts for five minutes using the pads of your index fingers after placing drops in the eyes. This will help keep the drops in the eyes where they are needed the most and keep the drops out of the nose (the tear ducts drain into the nose which is why we sniffle when we cry) where they can easily be absorbed into the bloodstream.

Some glaucoma eye drops lose their effectiveness at lowering IOP after they have been used for several years. This happens because the eye becomes less responsive to the drops. When this phenomenon occurs, a change of medications or a different type of treatment method may be needed.

Oral medication for glaucoma is rarely used due to the many systemic side effects that can occur. It may need to be used for short term treatment or in special cases.

There is a lot of exciting research being done looking for ways to improve the delivery of existing drugs to the eye (imagine having to use eye medication once a month rather than daily) and looking for new drugs that can lower IOP, prevent damage, or protect the optic nerve better than the current drugs available.

References:

1. Ritch R, Shields MB, Krupin T (Eds). The Glaucomas, 2^nd Edition. St. Louis, Missouri, USA, 1996, Mosby-Year Book, Inc.
2. Epstein DL, Allingham RR, Schuman JS (Eds). Chandler and Grant’s Glaucoma, 4^th Edition. Baltimore, Maryland, USA, 1997, Williams & Wilkins.
3. South East Asian Glaucoma Interest Group. Asia-Pacific Glaucoma Guidelines. Sydney, Australia, 2003-2004, SEAGIG.
4. European Glaucoma Society. Terminology and Guidelines for Glaucoma 2^nd Ed. Savona, Italy, 2003, EGS.