Reviewed By: Pramod Kerkar, MD, FFARCSI

Medications, laser treatments and surgical procedures are some of the beneficial approaches towards decreasing intraocular pressure and preserving eyesight but it is not necessary that all treatment approaches are effective for every individual. The patient should consult with the treatment provider to come up with a treatment plan that best suits the patient depending on the type of glaucoma, how severe it is, and how rapidly it is progressing among other factors.

If only minor damage is done to the optic nerves and there is minimal visual impairment, the best approach will be to reduce the IOP by about 30% below the average. If there is significant damage then other treatment options may be explored.

Most physicians initially inform the patient about options to decrease intraocular pressure through medications unless the patient is not deemed a candidate for medication use.

Additionally, when explaining a particular treatment option it is mandatory for the physician to inform the patient about the potential benefits, risks, and side effects. The decision making should take into consideration the comfort level of the patient, the tolerance level of medications, side effects, risks associated with it, and the recuperation period, and most importantly how effective the treatment will be in reducing intraocular pressure. If the treatment involves medication use, it is vital that the patient is diligent in taking the medications as instructed by the physician for best effectiveness.

What is the Best Eye Drops for Glaucoma?

Treatment of Glaucoma with Medications

Just like the brain, the eyes also have a protective mechanism to ward off any harmful agents. This hemato-ocular barrier makes prevent any injections or pills to get into the bloodstream. This is why most of the medications used for glaucoma are topical agents in the form of ointments or eyedrops which get absorbed within the eye itself and do not require to get into the bloodstream.

What is the Best Eye Drops for Glaucoma?

Prescription medications for glaucoma are divided into categories or classes, based on their mechanism of working. Majority of them are in the form of eyedrops.

Analogs of Prostaglandins. They function as vasodilators meaning that these medications promote expansion of blood vessels in the eye. Once this happens, the aqueous humor leaves the eye from uveo-scleral pathway from where it is eliminated by the lymphatic system. This class or category of medications can decrease intraocular pressures by 30% on average and has very little if any side effects like flu like symptoms or irritation of the eyes which wax and wane. In some cases, there can be discoloration of the eyes seen.

Beta-blockers. These agents alter the nervous system response from the receptors.

In cases of glaucoma, these medications lead to less production of aqueous humor which reduces the intraocular pressure significantly by about 25% on average. However, these medications have a significant side effect profile affecting eye, lungs, heart and certain other vital organs of the body.

Alpha (A2) Adrenergic Agonists. These medications also decrease production of aqueous humor reducing intraocular pressure by about 30%.

The Carbonic Anhydrase Inhibitor. These medications reduce the volume of aqueous humor, by partially constraining enzymes which produce them thereby reducing overall intraocular pressure by about 20%. They also help in improving blood flow to optic nerve and retina.

The Miotics. These are also known by the name of cholinergic agents. These agents contract the eye tissues and open up the drainage pathway thereby reducing intraocular pressure by about 30%.

Hyperosmotic Agents. They rapidly reduce intraocular pressure by decreasing volume of the vitreous which is a fluid that is filled in the cavity right behind lens of the eyes.

Conclusion

Till the date the group of beta-blockers are considered first-line drugs of choice, for its excellent efficacy in reducing intraocular pressure, long duration of action and few adverse ocular effects, although some authors consider the prostaglandin analogs of first choice. The place of beta-blockers as initial monotherapy is under debate.

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: January 21, 2019

This article does not provide medical advice. See disclaimer

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