Glaucoma medications & treatments
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Glaucoma is a chronic, progressive eye disease caused by damage to the optic nerve. The Centers for Disease Control and Prevention (CDC) estimates that about 3 million Americans have glaucoma. Around 80 million people in the world have glaucoma and it is the second leading cause of blindness worldwide.
There are often no early symptoms and 50% of people with glaucoma don’t know they have this condition. There is no cure for glaucoma but early detection and treatment for glaucoma can prevent vision loss.
What is glaucoma?
Glaucoma is a group of eye conditions characterized by optic nerve damage, which is essential for good vision. The progressive damage is usually due to fluid (aqueous humor) buildup in the front part of your eye, which will increase the pressure in your eye (intraocular pressure or IOP).
Anyone can get glaucoma, even if you have normal eye pressure. Certain groups are at higher risk than others. Risk factors include:
- Having a family history of glaucoma
- African Americans
- Anyone over the age of 60, especially if you are of Asian or Hispanic heritage
- Diabetics are twice as likely to develop glaucoma
- Have a thinner cornea than usual
- Eye injury or surgery
- Hypertension (high blood pressure)
- Long-term use of corticosteroids
How is glaucoma diagnosed?
To properly diagnose glaucoma, your ophthalmologist or eye doctor will take a look at your symptoms, your medical and family history, and perform a comprehensive eye exam.
Many cases of glaucoma don’t usually have symptoms in the early stages. The symptoms will depend on the type of glaucoma you have and the stage of your condition.
Open-angle glaucoma. This is the most common type of glaucoma, affecting up to 90% of Americans who have this condition. You don’t usually have any noticeable symptoms until you experience:
- Blind spots in your side (peripheral) or central vision, usually in both eyes
- Eye redness
- Hazy vision
- Tunnel vision, or loss of your peripheral vision in advanced stages
Angle-closure glaucoma. Also called narrow-angle glaucoma, symptoms of this type can develop suddenly (acute angle-closure glaucoma) and include:
- Blurred vision
- Severe eye pain
- Seeing halos around lights
In addition to asking about the symptoms of glaucoma you may be experiencing, your doctor may perform tests to confirm your diagnosis. These may include:
- Dilated eye exam. Checks for optic nerve damage. They may take images to compare during future visits.
- Tonometry. Measures the intraocular pressure.
- Visual field test. Checks for peripheral vision loss.
- Gonioscopy. Examines the angle in the eye where the iris meets the cornea.
- Pachymetry. Measures the thickness of the cornea.
What are some glaucoma treatment options?
The main treatment goal is to lower eye pressure, which can prevent any additional vision loss. Any vision loss you experienced before treatment is irreversible. Treatment options include medications and surgery.
Prescription eye drops are typically the first line of treatment. They treat glaucoma by lowering the pressure in your eyes by increasing the drainage of fluid from your eyes or decreasing the amount of fluid your eyes make. These include:
- Prostaglandins. These medications increase the outflow of fluid from your eye. They include
- Rho-Kinase Inhibitors. Meds such as Rhopressa (netarsudil) improve the outflow of the trabecular meshwork, which is the primary drainage system.
- Miotic or cholinergic agents. These meds include Isopto Carpine (pilocarpine) and Isopto (carbachol) but are rarely used due to side effects.
- Beta-blockers. They decrease the amount of fluid your eye produces and can include Betoptic/Betoptic S (betaxolol), Ocupress (carteolol), Betagan (levobunolol), Betimol (timolol hemihydrate), and Timoptic/Timoptic-XE (timolol maleate).
- Alpha-adrenergic agonists. These meds decrease the production of fluid in your eye as well as increase drainage. They are commonly used following minor eye surgery to keep your pressure from suddenly increasing. Examples include Alphagan P (brimonidine tartrate) and Iopidine (apraclonidine).
- Carbonic anhydrase inhibitors. Meds such as Trusopt (dorzolamide HCl) and Azopt (brinzolamide HCl) reduce the production of fluid and are usually used when other treatments were ineffective.
- Combination medications. There are also combination meds such as Cosopt (dorzolamide/timolol maleate) and Combigan (timolol/brimonidine tartrate) that increase the outflow as well as reduce the production of fluid in the eye.
Glaucoma surgery and laser treatment
If medications are not effective, your doctor may recommend procedures such as:
- Laser trabeculoplasty. This treatment is used to treat open-angle glaucoma. Your doctor will use a small laser to open clogs to help the fluid drain from your eye and reduce pressure. You may see some eye irritation and blurred vision immediately after this procedure but you usually can return to your normal daily activities the next day.
- Trabeculectomy. This is a surgical procedure used to relieve intraocular pressure by removing part of the eye’s trabecular meshwork.
- Drainage implant. This is typically an outpatient procedure where a shunt is placed in the sclera (white part of your eye) to increase fluid drainage.
- Minimally invasive glaucoma surgery (MIGS). This newer approach your doctor may recommend is considered safer than laser treatments and implant surgeries and has a quicker recovery time. There are several MIGS procedures available and are often combined with cataract surgery.
What is the best medication for glaucoma?
The best medication for the treatment of glaucoma will depend on the individual’s specific medical glaucoma, medical history, medications that the individual is already taking that may potentially interact with glaucoma medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter glaucoma medications approved by the Food and Drug Administration (FDA).
Best medications for glaucoma
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Xalatan (latanoprost)||Prostaglandin agonist||Eye drops||1 drop in affected eye(s) once daily in the evening.||Increase in brown pigmentation of the iris, blurred vision, burning and stinging, itching, foreign body sensation|
|Travatan Z (travoprost)||Prostaglandin agonist||Eye drops||1 drop in affected eye(s) once daily in the evening.||Increased pigmentation of the iris, redness, itching blurred vision, increased growth of eyelashes|
|Lumigan (bimatoprost)||Prostaglandin agonist||Eye drops||1 drop in affected eye(s) once daily in the evening.||Eye redness, increased growth of eyelashes, itching, dryness, burning, blurred vision|
|Zioptan (tafluprost)||Prostaglandin agonist||Eye drops||1 drop in affected eye(s) once daily in the evening.||Eye redness, increased growth of eyelashes, itching, dryness, burning, blurred vision|
|Vyzulta (latanoprostene bunod)||Prostaglandin agonist||Eye drops||1 drop in affected eye(s) once daily in the evening.||Eye redness, eye irritation, eye pain|
|Rhopressa (netarsudil)||Rho-Kinase inhibitor||Eye drops||1 drop in affected eye(s) once daily in the evening.||Eye redness, eye pain, blurred vision, watery eyes, bursting of blood vessels in the eye|
|Isopto Carpine (pilocarpine)||Miotic||Eye drops||1 to 2 drops in the affected eye(s) up to every 6 hours.||Headache, blurred vision, eye irritation, visual impairment, eye pain|
|Betoptic (betaxolol)||Beta-blocker||Eye drops||1 to 2 drops in the affected eye(s) every 12 hours.||Eye discomfort, blurred vision, itching, eye pain, foreign body sensation|
|Betoptic S (betaxolol)||Beta-blocker||Eye drops||1 drop in affected eye(s) every 12 hours.||Eye discomfort, blurred vision, itching, eye pain, foreign body sensation|
|Ocupress (carteolol)||Beta-blocker||Eye drops||1 drop in affected eye(s) every twice daily.||Eye redness, burning, watery eyes, eye irritation, blurred vision|
|Betagan(levobunolol)||Beta-blocker||Eye drops||1 to 2 drops in the affected eye(s) up to every 12 hours.||Eye irritation, visual disturbances, burning, redness|
|Betimol (timolol hemihydrate)||Beta-blocker||Eye drops||1 drop in affected eye(s) every 12 hours.||Burning, stinging, blurred vision, cataract, headache, itching|
|Timoptic(timolol maleate)||Beta-blocker||Eye drops||1 drop in affected eye(s) every 12 hours.||Burning, stinging, blurred vision, cataract, headache, itching|
|Timoptic XE (timolol maleate)||Beta-blocker||Eye drops||1 drop in affected eye(s) once daily.||Burning, stinging, blurred vision, cataract, headache, itching|
|Alphagan P (brimonidine tartrate)||Alpha-adrenergic agonist||Eye drops||1 drop in affected eye(s) every 8 hours.||Dryness, itching, redness, headache|
|Iopidine (apraclonidine)||Alpha-adrenergic agonist||Eye drops||1 drop one the eye undergoing surgery 1hr before surgery & repeated immediately after surgery.||Eye redness, itching, pain, blurred vision|
|Trusopt (dorzolamide hcl)||Carbonic anhydrase inhibitor||Eye drops||1 drop in affected eye(s) every 8 hours.||Eye burning, stinging, discomfort, bitter taste, allergic reaction, blurred vision|
|Azopt (brinzolamide hcl)||Carbonic anhydrase inhibitor||Eye drops||1 drop in affected eye(s) every 8 hours.||Blurred vision, bitter taste, dry eye, foreign body sensation, headache|
|Cosopt (dorzolamide/timolol maleate)||Carbonic anhydrase inhibitor/beta-blocker||Eye drops||1 drop in affected eye(s) every 12 hours.||Eye burning, stinging, bitter taste, blurred vision, headache|
|Combigan (brimonidine tartrate/timolol)||Alpha-adrenergic agonist /beta-blocker||Eye drops||1 drop in affected eye(s) every 12 hours.||Burning, stinging, redness, blurred vision, headache, itching|
|Simbrinza (brinzolamide/brimonidine)||Carbonic anhydrase inhibitor /alpha-adrenergic agonist||Eye drops||1 drop in affected eye(s) 3 times daily.||Eye redness, burning, stinging, dry mouth, blurred vision, dry eye|
|Rocklatan (latanoprost/netarsudil)||Prostaglandin agonist/ Rho-kinase inhibitor||Eye drops||1 drop in affected eye(s) once daily in the evening.||Eye redness, pain, itching, visual disturbances, cornea abnormalities, bursting of blood vessels in the eye|
Your healthcare provider will determine the right dosage based on your response to the treatment, medical glaucoma, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of glaucoma medications?
As with all medicines, those used for glaucoma will have some side effects, depending on the class you are taking. The most common side effects include:
- Red eyes
- Itchy or burning eyes
- Eye pain
- Blurred vision
- Darkening of your eye color
- Feeling like there is something in your eye
- Watery eyes
Other possible side effects may exist; this is not a complete list.
What are some home remedies for glaucoma?
Glaucoma is a life-long condition with serious complications that require continual follow-up with your eye doctor and treatment. Home remedies will not cure glaucoma but can help control eye pressure and keep your eyes healthy.
In addition to medications, the following things may help reduce your risk of developing glaucoma:
- Regular exercise may help reduce eye pressure in open-angle glaucoma.
- Eat a healthy diet full of vitamins and nutrients that are essential for eye health. These include zinc, copper, selenium, and antioxidant vitamins A, C, and E.
- Limit or avoid caffeine as it can increase your eye pressure.
- Sleep with your head elevated. This has been shown to reduce eye pressure while you sleep.
- Stop smoking. Smoking increases your risk of diabetes and cataracts, both of which are risk factors for developing glaucoma.
Frequently asked questions about glaucoma
Will I go blind if I have glaucoma?
For most patients, the answer is no. Complete blindness can occur if you have glaucoma but it only happens in about 5% of glaucoma patients. Having some vision loss or impairment is more common and occurs in about 10% of patients.
What is the first sign or symptom I will see if I have glaucoma?
In the early stages of glaucoma, many people don’t have any noticeable symptoms. The first sign you may notice is a narrowing or loss of your peripheral vision, called tunnel vision.
Is there a cure for glaucoma?
Currently, there is no cure for glaucoma, although research is ongoing. Through medications and other treatments, however, you can slow the progression of glaucoma.
Can my vision loss be reversed or restored?
Unfortunately, any vision loss that occurs before you start treatment cannot be restored at this time. Researchers are working on ways to reverse damage to the optic nerve from glaucoma and other neurodegenerative diseases.
What is considered normal eye pressure?
There is no single number or percentage that is considered normal eye pressure. Your eye pressure should be between 12-22 mg hg but this may vary for different individuals. While this can be a risk factor for glaucoma, some people still develop glaucoma with normal eye pressure.
Related resources for glaucoma
- What is glaucoma? Symptoms, causes, diagnosis, and treatment. American Academy of Ophthalmology
- Glaucoma overview. MayoClinic
- At a glance: Glaucoma. National Eye Institute
- What is glaucoma? WebMD
- Glaucoma information. Hopkins Medicine
- Glaucoma symptoms and causes. Cleveland Clinic
- What is Glaucoma? Glaucoma research foundation
- What is Glaucoma? Diabetes.org
- Don’t let glaucoma steal your sight. Centers for Disease Control and Prevention
- Frequently asked questions about glaucoma. Glaucoma research foundation