Glaucoma Treatment

There are two primary methods used in glaucoma treatment – glaucoma medication usually in the form of eye drops, and glaucoma surgery. The progression of loss of vision can practically be halted if the eye pressure can be lowered to within certain parameters. Since eye pressure is due to the increase of fluids called “aqueous humor” coming into the eye and not being able to drain out, there are two ways the reduction of pressure occur:

• Decrease the amount of aqueous fluid coming in – decrease its production.
• Increase the amount of fluid going out – the outflow, through the eye’s pathways.

Glaucoma eye drops are absorbed into the blood vessels of the eye, and some goes into the overall blood system. Therefore, if a patient has other medical concerns, i.e, breathing problems such as asthma, or heart problems, these medications may not be optimal. Glaucoma eye drops can interact with other medicines, such as digitalis for the heart. Before your eye doctor prescribes anything, you will be asked for a full health history and current medication update.

Glaucoma eye drops are categorized according to the active ingredient that makes it work. The glaucoma treatment information below is just a general overview. Always consult your eye specialist before making any conclusions.

Alpha-adrenergic agonists – These reduce production of fluid and can be used with other eye drops or alone. Side effects are itching, redness, bloodshot eyes, raising of the upper eyelid, and enlargement of the pupil. FDA-approved drugs are Alphagan, Alphagan-P, and Iopidine.

Beta-blockers – This glaucoma treatment decreases the fluid production in the eye. They are often used along with other eye drops. They may cause problems for people who have heart conditions, as they tend to reduce heart rate. Depression and diabetes, along with their medications, also are problematic. Lung disease can also be adversely affected by beta-blockers. Your doctor should know your specific medical history before prescribing these. FDA-approved drugs are Betoptic S, Istalol, and Timoptic.

Carbonic anhydrase inhibitors – These decrease fluid production. They are not used alone, but along with other eye drops. They can also be taken as pills. Side effects include bitter taste after taking, burning, and redness. FDA-approved drugs are Azopt , Daranide, Diamox, Neptazane, and Trusopt. Those that come in oral form can cause side effects, such as depression, loss of appetite, weight loss, fatigue, loss of libido, and tingling fingers and toes.

Epinephrine – These not only decrease production fluid, but also increase its outflow. Side effects are heart palpitations, increase in heart rate, blocked tear ducts, and pigmented deposits in the eye. FDA-approved drugs are epinephrine and Propine.

Hyperosmotics – These are used for high amounts of eye pressure when optic nerves are in danger of permanent damage. They are usually given on a one-time basis as an emergency to reduce fluid in the eye. FDA-approved drugs are glycerin (taken orally), isosorbide (taken orally), and mannitol and urea (taken intravenously).

Parasympathomimetics – These increase the outflow of fluids from the eyes. They cause the pupil to constrict, which in turn helps the blockage and drainage. Side effects are burning, difficulty seeing at night, pupil constriction, aching brow. FDA-approved drugs are carbachol, demecarium, echothiophate, and pilocarpine.

Prostaglandins – These are usually used once a day and are easiest. They relax the eye muscles and allow fluids to drain better, so eye pressure is reduced. Side effects include changing the color of the eye due to increased pigment, burning and stinging, and lengthening of eyelashes. Reports indicate these are the most widely used. FDA-approved drugs are Xalatan, Lumigan, Travatan Z, and Resucla.

There are a couple medications that contain a combination of two in one bottle. Ask your doctor if these would be right for you.

Many of the above glaucoma medication come in generic form. As with any medication, ask your doctor about the full range of side effects, and if any will interfere with your current health conditions or medications.

Sometimes medication is not a sufficient glaucoma treatment, or cannot be taken due to other health considerations. In that case, your doctor may opt to perform surgery. Two types of surgery are available: laser, or making a small cut in the eye to reduce pressure.

Laser Surgery
In glaucoma laser surgery, a tiny beam of light is directed into the drainage meshwork of the eye, causing small scarring. The eye is numbed and there is little pain. The scars assist in draining fluid out of the eyes. However, some people experience temporary increase in eye pressure. Glaucoma laser surgery may also result in pressure levels that are too low, so the eye cannot hold its shape. Medications can be used with these conditions. There are several different approaches that glaucoma laser surgery can use, dependent on the type of glaucoma. Generally, patients recover quickly, within days. There may be a small risk of developing cataracts. This also can be addressed by your doctor should it occur. The benefits of glaucoma laser surgery outweigh the risks. Laser surgery is usually recommended before cutting the eye.

Filtering Microsurgery
This type glaucoma surgery is done with a small cutting instrument that makes tiny slits into the eye to create tiny drainage holes in the white part of the eye (the sclera). Relaxing medications are first given, and then a local anesthesia is used and there is no pain. Sometimes sedation by intravenous methods is used. After sedation, another injection is given into the eye to keep it still, and this again is not felt. During surgery the patient will be drowsy and relaxed and will not experience any pain. This is an out-patient glaucoma surgery procedure with no overnight stay. Daily activities should be kept to a minimum with no driving, reading, heavy lifting, etc. There may be blurry vision for about a week, but then it should return to as it was pre-surgery.

This procedure is only used if glaucoma laser surgery was not successful in lowering eye pressure, or if the pressure increased again. Sometimes the holes begin to close, so repeat surgery can be performed.

There are many other types of glaucoma treatment that are currently under study. Some involve increasing blood supply to the optic nerve, and developing a type of neuro-protection. One interesting glaucoma study involves the well-known herb ginkgo biloba, which may protect the optic nerve or widen the area of vision. These experimental studies are not conclusive and are ongoing.

Another glaucoma study is the use of marijuana and its derivatives. This showed lowering of eye pressure temporarily, but lowering glaucoma symptoms of eye pressure does not necessarily control the disease. Marijuana did not show any advantage over standard approved drugs or surgery as a glaucoma treatment.

Acupuncture, based on the belief of the flow of energy through pathways or meridians, these glaucoma studies did show some temporary improvement in central vision, but no change in eye pressure. Likewise, other alternative glaucoma treatments like chiropractic, massage, and meditation may have therapeutic effects in relieving stress associated with glaucoma symptoms, but they did not control eye pressure.

Exercisealso showed some positive results. Isokinetic exercise, such as a bicycle, and aerobic exercise lower pressure and improve blood flow to eye nerves. Even walking 20 minutes per day, four times per week showed these benefits. And, of course, regular exercise is also good for a whole range of other elderly issues.

Caffeine should be avoided or greatly reduced by glaucoma patients, as it can increase eye pressure. Black or green tea, however, contains antioxidants which are good for both the heart and eyes. These can be taken in moderation.

Your doctor will discuss with you various glaucoma treatment options available, explain in more detail their side effects and outcomes, and choose which approach is right for you. The main goal is to detect the onset of glaucoma so that minimal treatment is needed.

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