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What types of treatment methods are available for glaucoma?
The only proven method of treatment for glaucoma
is reducing the pressure inside the eye. There are three ways to lower the eye
pressure for glaucoma: medications (usually taken as eye drops), laser
treatment, and surgical treatment. For most patients with newly diagnosed or
easily controlled glaucoma, one or more types of eye drops are used daily. Some
patients’ eye pressures cannot be adequately controlled with eye drops (or the
patients have allergies to or side effects from medication) and laser treatment
or surgery is needed. Sometimes, laser treatment can be performed first to treat
open-angle glaucoma, but medication is frequently needed later. If medication
and laser both fail to control intraocular pressure, surgery (usually a
trabeculectomy) becomes necessary. For severe cases of glaucoma, less common
procedures (such as a glaucoma implant) are performed.
Laser treatment is required early in most cases of
angle-closure glaucoma and is used as an alternative or supplement to treatment
in open-angle glaucoma.
The goal in treating glaucoma is to preserve the
patient's vision by reducing intraocular (inside the eye) pressure and
protecting the optic nerve.
Medical therapy
There are several classes of medications
used to treat glaucoma, with many advances having been made over the past
several years. Each medication has a different mechanism of reducing pressure,
either working to reduce the production of aqueous humor (fluid in the front
part of the eye), or to reduce the resistance to the outflow of aqueous. These
medications can be used individually or together to complement each other. Side
effects can occur are uncommon. Your doctor will explain which medication is
right for you. Please let your doctor know if you believe you are experiencing
side effects from your glaucoma medication.
The following medications can be used to treat
glaucoma:
- Beta-blockers:
Beta-blockers (betaxolol, carteolol, levobunolol, metipranolol, timolol)
work by reducing aqueous production. They have a long, proven track record
of effectiveness and are used once or twice daily. They are inexpensive and
safe for most patients, but beta-blockers should NOT be used by patients
with asthma, chronic lung disease, heart-block, hypotension, or severe heart
failure.
- Alpha-2 agonists: These
medications (apraclonidine, brimonidine) also work by reducing aqueous
production. They are slightly less effective than beta-blockers and are used
twice daily. Their side effects can include an allergic reaction, redness or
irritation in the eyes, occasional headaches, and--in rare instances-- a
decrease in mental alertness.
- Carbonic anhydrase inhibitors:
These medications work by reducing aqueous production. The side effects of
oral carbonic anhydrase inhibitors (acetazolamide, methazolamide) include
fatigue, loss of appetite, numbness and/or tingling in the hands and feet,
and stomach upset. When used as a topical medication (brinzolamide,
dorzolamide), carbonic anhydrase inhibitors are a little less effective, but
there are very few side effects except occasional allergic reactions.
- Prostaglandins:
Prostaglandins (bimatoprost, latanoprost, travoprost, unoprostone) work by
decreasing the resistance to aqueous outflow and have been shown to be very
effective in reducing intraocular pressure. Side effects include redness,
irritation or inflammation in the eye, darkening of the iris color and an
increased growth of eyelashes.
- Miotics: Miotics such as
carbachol, echothiophate, and pilocarpine are effective and inexpensive.
However, their side effects of brow ache and dim or blurred vision have
reduced their use.
- Combination
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