Dr. John B. Cox and Dr. Heather Estopinal

Alpha Agonists for the Treatment of Glaucoma

While there is no cure for glaucoma, it can be controlled with proper management.

Elevated intraocular pressure (IOP) can damage the optic nerve, which may lead to vision loss. Treatment for glaucoma focuses on lowering the IOP to a level that is less likely to cause further optic nerve damage. This is known as the “target pressure.” The target pressure differs from individual to individual. Your target pressure may change during your course of treatment.

If you have glaucoma, your ophthalmologist (Eye M.D.) may prescribe medication to lower your eye pressure. There are many more choices for topical treatment with eyedrops today than there were only a few years ago. Your ophthalmologist has chosen an alpha agonist medication to treat your glaucoma.

How Do Alpha Agonists Work?
Alpha agonist medications are reliable for lowering the intraocular pressure. They work by decreasing the production of the fluid that the eye continually makes, called the aqueous humor.

What Are the Alpha Agonists?
There are three alpha agonist drugs:

• apraclonidine (Iopidine)
• brimonidine (Alphagan, Alphagan P)
• dipivefrin (Propine)

Possible Side Effects of Alpha Agonists
All medications, including eye drops, can have side effects. Some people taking alpha agonist eye drops may experience

• dry mouth
• ocular allergy with a red eye or red eyelids
• tiredness or fatigue

Beta Blockers for the Treatment of Glaucoma

While there is no cure for glaucoma, it can be controlled with proper management.

Elevated intraocular pressure (IOP) can damage the optic nerve, which may lead to vision loss. Treatment for glaucoma focuses on lowering the IOP to a level that is less likely to cause further optic nerve damage. Your ophthalmologist has chosen a beta-blocker medication to treat your glaucoma.

How Do Beta Blockers Work?
Beta-blocker (beta adrenergic antagonist) medications are reliable for lowering intraocular pressure. They work by decreasing the amount of fluid that the eye continually produces, called the aqueous humor. For many years, beta blockers were the mainstay of treatment. Thus, we have a lot of experience with this medication for the treatment of glaucoma.

Types of Beta-Blocker Medications
There are two general classes of beta blockers: nonselective and selective.

The nonselective beta blockers include:  levobunolol (Betagan, AKBeta); carteolol (Ocupress); metipranolol (Optipranolol); timolol (Timoptic, Betimal, Istalol); and timolol gel (Timoptic XE).  Generic versions of timolol and timolol gel are now available. Consult with your ophthalmologist to be sure that a generic product is an acceptable alternative for you.

The only available selective beta-blocker medication is betaxolol (Betoptic, Betoptic S).

While a selective beta-blocker eye drop has a better safety profile, especially in terms of respiratory symptoms, it still must be used with caution in patients with asthma or emphysema. The eye pressure-lowering effect is slightly less with selective beta blockers.

Possible Side Effects of Beta Blockers
All medications, including eye drops, can have side effects. Some people taking beta-blocker eye drops may experience

• wheezing or difficulty breathing
• slow or irregular heart beat or decreased response of heart rate to exercise
• increased risk for heart failure
• depression
• impotence
• headache, dizziness or weakness
• in diabetics, difficulty sensing blood glucose changes
• eye irritation or allergy

Carbonic Anhydrase Inhibitors for the Treatment of Glaucoma

While there is no cure for glaucoma, it can be controlled with proper management.   Elevated intraocular pressure (IOP) can damage the optic nerve, which can lead to vision loss. Your ophthalmologist has chosen a carbonic anhydrase inhibitor (CAI) medication to treat your glaucoma.

How Do CAIs Work?
CAI medications are very reliable at lowering the intraocular pressure. They work by decreasing the production of the fluid that the eye continually makes, called the aqueous humor.

What Are CAI Medications?
Topical drugs: dorzolamide (Trusopt) and brinzolamide (Azopt).

Oral medications: acetazolamide (Diamox, AK-Zol); acetazolamide sustained-release (Diamox Sequels); and methazolamide (Neptazane, GlaucTabs).

Possible Side Effects of CAIs
All medications, including eye drops, can have side effects. Some people taking topical carbonic anhydrase medications (eye drops) experience:

• blurred vision
• bitter taste in the mouth
• dry eyes
• eye irritation or allergy with a red eye or red eyelids
• headache or dizziness
• upset stomach

The oral (pill) form of these medications has more side effects, including:

• increased need to urinate
• tingling sensation in fingers and toes
• rarely, severe allergic reactions or blood disorders can occur
• change in taste (especially with carbonated beverages)
• unusual tiredness or weakness

WARNING
These medications are sulfonamides. If you are allergic to sulfa antibiotics, the same types of adverse reactions can occur with carbonic anhydrase inhibitors. Also, rare adverse drug interactions have occurred in patients taking high doses of aspirin and carbonic anhydrase inhibitors. For glaucoma medications to work, you must take them regularly and continuously as prescribed by your doctor.

 Prostaglandin Analogs for the Treatment of Glaucoma

While there is no cure for glaucoma, it can be controlled with proper management.   Elevated intraocular pressure (IOP) can damage the optic nerve, which can lead to vision loss. Treatment for glaucoma focuses on lowering IOP to a level that is unlikely to cause further optic nerve damage. This is known as the “target pressure” or “goal pressure.” The target pressure differs from individual to individual. Your target pressure may change during your course of treatment.

If you have glaucoma, your ophthalmologist (Eye M.D.) may prescribe medication to lower your eye pressure. There are many more choices for topical treatment of glaucoma today than there were only a few years ago. Your ophthalmologist has chosen to use a prostaglandin analog medication to treat your glaucoma.

How do prostaglandin analogs work?
Prostaglandin analogs lower IOP by increasing the outflow of the aqueous humor, the fluid made continuously by the eye. These medications are taken once a day.

What are the prostaglandin analog medications?

latanoprost (Xalatan), bimatoprost (Lumigan),  travoprost (Travatan), tafluprost (Zioptan)

Possible side effects of prostaglandin analogs or prostamides
All medications, including eye drops, can have side effects. Some people taking these eye drops may experience

• redness of the eye
• darkening of the iris (the colored part of the eye); this color change occurs slowly and may not be noticeable for months or even years
• increased growth, thickness, and pigmentation of the eyelashes
• eye irritation or itching
• blurred vision
• darkening of the eyelid skin
• muscle aches (rare)
• headaches (rare)

Patients with a history of uveitis (inflammation in the eye), ocular herpes infection, or swelling in the retina (called cystoid macular edema) should use this medication with caution. If you have a history of any of these conditions, please discuss it with your doctor.