When dealing with glaucoma, many people are concerned with the idea of eye surgery to lower pressure within the eye.
While this may be an option in some cases, other glaucoma treatments are available.
Glaucoma medications are one treatment option that can help lower eye pressure and slow down the progression of the disease.
These medications come in many forms, including eye drops and pills.
They can also be prescribed in a variety of combinations.
So, it is important to work with an ophthalmologist to find the best medication(s) for you.
Types of Medicine to Treat Glaucoma
There are several types of medicine used to treat glaucoma.
Some of these medications work to lower the pressure inside the eye, while others help improve the flow of fluid out of the eye.
Before prescribing a medication, your doctor will consider the severity of your glaucoma and any other health problems you may have.
Sometimes, your doctor will need to do some glaucoma tests.
You will also have regular exams by your doctor to check that the medication is working and not causing side effects.
The most common types of medicine used to treat glaucoma are:
Eye Drops
Glaucoma eye drops are the most common type of medication used to treat the condition.
They work by decreasing the amount of fluid in your eye.
As a result, they can lower the pressure inside your eyes and help keep nerve damage from getting worse.
When using this type of medication, it is important to:
- Use the drops exactly as prescribed by your doctor
- Not stop using them without talking to your doctor first
- Wait at least 15 minutes after putting in the drops before you do anything else, including washing your face. This will give the medicine enough time to work
- Avoid touching the dropper against your eye or anything else, including your eyelid
- Do not share your glaucoma medication with anyone. If you have to stop using them for any reason, talk to your doctor first and start again when it is safe
Your doctor will want to check how well these drops are working and that they aren’t causing side effects.
There are several types of eye drops used to treat glaucoma, including:
Prostaglandin Analogs
Prostaglandin analogs work by increasing the outflow of fluid from your eyes. In turn, this reduces the pressure in your eyes.
These drops are more effective in lowering eye pressure in patients with open-angle glaucoma.
However, they are less effective in patients with narrow-angle glaucoma.
They are also used to treat other eye conditions like iritis, uveitis, and corneal inflammation (inflammation of the outermost layer of your eyes).
They come in several different brands, including:
- Xalatan (latanoprost)
- Lumigan (bimatoprost)
- Travatan (travoprost)
- Zioptan (tafluprost)
Beta-Blockers
Beta-blockers work by slowing the production of aqueous humor.
This decreases the amount of fluid that flows into your eyes, and in turn, lowers your eye pressure.
These drops are more effective when used in combination with other glaucoma medications.
Beta-blockers are more effective in patients with normal eye pressure or low to average intraocular pressures.
They are believed to reduce IOP by 20-30% from baseline successfully.
Examples include:
- Timolol (Betimol, Timoptic)
- Betoptic (betaxolol)
Using the punctal occlusion technique can help lower the odds of systematic side effects of beta-blockers.
A punctal occlusion is a procedure that involves plugging the tear ducts of your eyes.
This helps keep drops from draining into your nose or throat and getting into the bloodstream.
Alpha-adrenergic Agonists
These medications work by decreasing the production of fluid (aqueous humor) in the ciliary body and increasing drainage.
The most commonly used alpha-adrenergic agonist eye drops in glaucoma are:
- Brimonidine (Alphagan P, Qoliana)
- Apraclonidine (Iopidine)
Carbonic Anhydrase Inhibitors
Carbonic anhydrase inhibitors (CAIs) are a type of glaucoma medication that reduces fluid production in the eye.
This helps to lower IOP and prevent further damage to the optic nerve.
There are several different CAI eye drops available, including:
- Brinzolamide (Azopt)
- Dorzolamide (Trusopt)
They are also available in pills, including
- Acetazolamide (Diamox)
- Methazolamide (Neptazane)
Patients who take CAIs may need to have their blood regularly monitored to ensure that the medication is not causing any adverse effects.
One of the main benefits of CAI medications is that they can be used in patients with normal eye pressure.
This makes them a good option for those at risk of developing glaucoma but do not yet have high eye pressure.
Combined Medications
A few different medications can be used in combination to treat glaucoma.
By using more than one medication, the pressure within the eye is lowered, and the risk of glaucoma vision loss is decreased.
The most common medications used in combination are:
- Alpha-adrenergic and Carbonic anhydrase inhibitors, such as brimonidine and brinzolamide (Simbrinza)
- Carbonic anhydrase inhibitors and beta-blockers, such as timolol and dorzolamide (Cosopt)
- Alpha agonists and beta-blockers, such as brimonidine and timolol (Combigan)
Each combination has its own set of benefits and risks, so it is important to discuss your treatment options with your doctor.
Cholinergic Agents
These medications constrict the pupil, so they typically decrease pressure in the eye by improving drainage.
Though cholinergic agents are rarely used in glaucoma patients, they do have a role in treating acute closed-angle glaucomas or chronic open-angle glaucoma.
Additionally, they are used to lower intraocular pressure (IOP) in ocular hypertensive patients who do not respond to other medications.
This class of medications includes pilocarpine (Isopto Carpine)
Pills
There are a few different types of pills that your doctor may prescribe to help treat glaucoma.
Mostly, this happens if the eye drops aren’t working as well as your doctor would like after a certain amount of time.
They are prescribed on a case-by-case basis, depending on the pressure level inside your eye.
Most often, carbonic anhydrase inhibitors like Acetazolamide (Diamox) and Methazolamide (Neptazane) are your doctor’s first choice.
These help to lower the pressure in your eye by decreasing the production of fluid in your eye.
What are the Side Effects of Glaucoma Medications?
Most medications for glaucoma have relatively few side effects.
However, everyone reacts differently to medication, so it is important to discuss potential side effects with your doctor before starting treatment.
Some common side effects of these medications include:
-
- Blurry vision or nearsightedness
- Headache, dizziness, nausea
- Changes in your eyelid color
- Dry mouth
- Depression
- Fatigue
- Nasal congestion
- Stinging or burning in your eye when you put the drops
- Redness in your eye
These side effects may differ depending on the medication you are taking.
If you experience any bothersome side effects from your glaucoma medication, talk to your doctor about adjusting your dose or switching to a different medication.
For How Long Do We Need to Use Eye Drops?
Glaucoma eye drops are administered in a similar 1manner at the same time every day.
Depending on which medication they are prescribed, some patients need to use eye drops once or twice daily for at least six months.
Note that using eye drops more often than prescribed may not necessarily improve the pressure behind the eye and could cause more side effects.
Your ophthalmologist will work with you to create a treatment plan best suited for your individual needs.
Be sure to follow all instructions closely, and if you have any questions or concerns, don’t hesitate to contact your doctor.
Also, continue using the drops as prescribed even after your symptoms improve. This can help prevent you from having to deal with the disease again in the future.
Alternative to Medication
Surgery
Depending on your age, health, and how bad the damage to your eye has become, surgery might be a good choice for you.
Since any type of operation carries some risk, it’s important to talk with both your doctor and an ophthalmologist about whether this treatment is a good option for you.
Several types of surgery can be used to treat glaucoma, including laser surgery, drainage surgeries, and trabeculectomy (a type of filtering surgery).
Laser Surgery
A laser beam is used to make minor burns in the eye tissue during laser surgery.
The aim of these “burns” (which are actually very tiny holes) is to reduce pressure inside your eyes and promote better drainage of fluid from them.
The type of laser surgery used will depend on the type of glaucoma you have and how severe it is.
Laser surgery is usually performed in an outpatient setting.
This means that it does not require a stay at the hospital or clinic and can be done on a day when you’re not working.
If you decide to go through with the surgery, your eye will be numbed first to prevent discomfort.
After the surgery is completed, you may need to use eye drops for a few weeks to help your eyes heal properly.
The results of laser surgery can be immediate or take a few months to show improvement.
Some common types of laser surgery for glaucoma include:
Argon Laser Trabeculoplasty (ALT)- The argon laser beam is used to create a small opening in the eye’s drainage canals.
This allows more fluid to flow out of the eye, lowering pressure.
ALT is usually successful in reducing intraocular pressure for about 70% of people who have it performed.
Most often, it is used for primary open-angle glaucoma treatment.
Only half of the fluid channels are treated during a single session to prevent over-correction.
The remaining fluid channels are treated during a second session if needed.
This approach helps to lower the risk of increased pressure following surgery, which can damage the optic nerve.
Additionally, it is less likely to cause inflammation or scarring than some other types of laser surgery.
Laser Peripheral Iridotomy (LPI)- LPI involves using a laser to make a small hole in the colored part of the eye, called the iris.
This helps fluid drain from the eye more easily and lowers pressure.
LPIs successfully reduce intraocular pressure for patients with narrow angles and narrow-angle glaucoma.
The procedure is quick and typically painless.
There may be some mild discomfort following the surgery, but it should go away within a few days.
Most people can return to their normal activities within a few days after surgery, although it’s important to be careful not to bump the eye.
YAG Laser Trabeculoplasty (YTTR)- The YAG laser beam creates a small opening in the eye’s drainage canals to increase fluid flow out of the eye and lower pressure.
Like with ALT, this procedure is used for primary open-angle glaucoma and is usually done in an outpatient setting.
The laser is directed into the eye and a short pulse of light is released. You may hear a popping noise and see a flash of light. This procedure lasts for a few minutes.
You will need to rest for about 15 minutes after the YAG laser trabeculoplasty. The doctor will then examine your eyes to see if the treatment has been effective.
There are some risks associated with YAG laser trabeculoplasty, including infection and inflammation within the eye, bleeding in the back of the eye, retinal detachment, increased pressure inside the eye, and cataracts.
Selective Laser Trabeculoplasty (SLT) – SLT is a minimally invasive procedure that uses a low-energy laser to create new drainage pathways in the eye.
SLT is a quick and relatively painless procedure, and it only focuses on the cells that need treatment, leaving the rest of the trabecular meshwork intact.
Since SLT is a minimally invasive procedure, it carries a low risk of side effects and complications.
SLT is an excellent treatment option for people with open-angle glaucoma who are not candidates for medication or surgery.
Additionally, it may be an alternative to surgery for those who have not responded well to pressure-lowering eye drops or medication.
However, it does not offer long-term protection against increased intraocular pressure or slow optic nerve damage
Drainage Surgeries
These surgeries involve the insertion of a tube between the cornea and sclera.
The surgeon inserts this small tube shunt to drain or re-route fluid from your eye into another area where your system can absorb it.
A few different drainage surgeries can be performed, including trabeculectomy, canaloplasty, and glaucoma drainage implant.
Trabeculectomy
This is the most common type of filtering surgery.
It is typically done when medications and laser surgery aren’t enough to maintain appropriate pressure in the eye.
This surgery involves making a small incision on the side of your cornea (the clear part of your eye) and removing some tissue underneath it, called the trabecular meshwork.
A new opening for fluid flow forms between this tissue and the white part of your eye (sclera), allowing fluid to drain from the eye more effectively.
While trabeculectomy is a common surgery, it does come with some risks.
These can include bleeding inside the eye, infection, increased pressure in the eye after surgery (which could lead to additional vision loss), and glaucoma.
That is why, following this surgery, you may need to take medicine to avoid scar tissue from developing.
Therapy
Researchers are continuously exploring new therapies for glaucoma.
Some of the current research includes investigating the use of anti-fibrotic therapy and gene therapy.
Anti-fibrotic therapy involves using medication to stop the formation of excess fibrous tissue in the trabecular meshwork.
This therapy is currently being investigated as a potential treatment for open-angle glaucoma.
Gene therapy involves introducing a gene into the eye to help protect retinal ganglion cells from damage.
Research on gene therapy by Harvard Medical School researchers has shown promise in animal models by preventing optical nerve damage and preserving retinal ganglion cells.
Therefore, this therapy may be a potential treatment for glaucoma-induced blindness.
Final Verdict
While many different medications are prescribed to help treat glaucoma, some may work better than others, depending on the individual’s case. Some of the most common medications used to treat glaucoma include prostaglandin analogs, beta-blockers, and carbonic anhydrase inhibitors. While these medications can effectively reduce the pressure within the eye, they may also cause some side effects. For this reason, it’s important to work with your doctor to find the medication that works best for you.
Sources
https://www.webmd.com/eye-health/which-medicines-treat-glaucoma
https://www.webmd.com/eye-health/need-glaucoma-surgery
https://www.glaucoma.org/news/blog/new-medical-therapies-offer-hope-for-glaucoma-patients.php
https://www.mayoclinic.org/diseases-conditions/glaucoma/diagnosis-treatment/drc-20372846
https://www.glaucoma.org/gleams/glaucoma-medications-and-their-side-effects.php
https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma/glaucoma-surgery
Frequently Asked Questions
What is the best medication for glaucoma?
There is no one “best” medication for glaucoma. Instead, your doctor will work with you to find the drug that works best for your case. The most common medications used to treat glaucoma include prostaglandin analogs, beta-blockers, and carbonic anhydrase inhibitors.
What is the first-line drug for glaucoma?
Eye drops are the first-line drug for glaucoma. They help lower the high eye pressure by decreasing the production of fluid. They also reduce the rate at which fluid builds up. This can help to prevent or slow down damage to your optic nerve.
What are the oral medications for glaucoma?
There are a few different oral medications that can be used to treat glaucoma. The most common ones are Acetazolamide (Diamox) and Methazolamide (Neptazane), which helps to reduce the pressure in your eye.
Is there an alternative to eye drops for glaucoma?
Yes, there is an alternative to eye drops for glaucoma. Some people may instead choose to take oral medications to help reduce the pressure in their eyes. Others may choose to have glaucoma surgery to help reduce the pressure in their eyes. Whichever route you decide to take, it is important to speak with your doctor to determine what is best for you.
What is normal eye pressure?
The normal eye pressure range is around 12-21 millimeters of mercury (mmHg). Anything above or below this range may be cause for concern. If you are experiencing high eye pressure, your doctor will likely prescribe medication to help lower it.
