From the Guidelines
The typical treatment for glaucoma focuses on lowering intraocular pressure to prevent optic nerve damage and vision loss, with first-line therapy usually involving prescription eye drops such as prostaglandin analogs used once daily in the evening, as recommended by the most recent guidelines 1.
Treatment Options
- Prostaglandin analogs (e.g., latanoprost, travoprost, bimatoprost) are the most frequently prescribed initial eye drops for lowering IOP in patients with glaucoma due to their efficacy, tolerability, and once-daily dosing schedule 1.
- Beta-blockers (e.g., timolol 0.25-0.5%) can be used as an alternative or in combination with prostaglandin analogs, applied twice daily 1.
- Other medications, such as alpha-2 agonists (e.g., brimonidine), carbonic anhydrase inhibitors (e.g., dorzolamide), and fixed-combination drops, may be added if a single medication is insufficient 1.
Additional Interventions
- Laser procedures, such as selective laser trabeculoplasty (SLT), can improve drainage for patients who don't respond adequately to medications 1.
- Surgical interventions, including trabeculectomy or implantation of drainage devices, may be required in advanced cases 1.
Adherence and Monitoring
- Treatment is lifelong and requires consistent adherence to prevent progressive vision loss, as glaucoma damage is irreversible 1.
- Regular monitoring of intraocular pressure, visual fields, and optic nerve appearance is essential to assess treatment effectiveness and disease progression 1.
- Patient education and informed participation in treatment decisions may improve adherence and overall effectiveness of management 1.
From the FDA Drug Label
The dosage employed in the treatment of chronic simple (open-angle) glaucoma ranges from 250 mg to 1 g of acetazolamide per 24 hours, usually in divided doses for amounts over 250 mg. In treatment of secondary glaucoma and in the preoperative treatment of some cases of acute congestive (closed-angle) glaucoma, the preferred dosage is 250 mg every four hours, although some cases have responded to 250 mg twice daily on short-term therapy
The typical treatment for glaucoma includes the use of acetazolamide with a dosage ranging from 250 mg to 1 g per 24 hours for chronic simple (open-angle) glaucoma, and 250 mg every four hours for secondary glaucoma and acute congestive (closed-angle) glaucoma 2.
- Key points:
- Dosage should be adjusted with careful individual attention to symptomatology and ocular tension.
- Continuous supervision by a physician is advisable.
- Acetazolamide can be used in conjunction with miotics or mydriatics as needed.
- Another option is timolol maleate ophthalmic solution, however, it should not be used alone in the treatment of angle-closure glaucoma 3.
From the Research
Typical Treatment for Glaucoma
The typical treatment for glaucoma involves reducing intraocular pressure (IOP) to prevent optic nerve damage and preserve visual function 4, 5, 6.
- First-line therapies: Topical medications, such as prostaglandin analogs, beta-blockers, and carbonic anhydrase inhibitors, are often used as first-line therapies to reduce IOP 7, 5, 6.
- Combination therapies: Combination therapies, including fixed combinations of two medications in a single bottle, may be used to simplify the dosing regimen and increase patient adherence 4.
- Emerging treatments: New drugs are being developed to treat glaucoma, including those with novel mechanisms of action and improved tolerability 7.
- Treatment selection: The selection of a treatment for glaucoma should consider factors such as efficacy, adverse effects, patient preferences, and cost 6.
Medication Options
Various medications are available to treat glaucoma, including:
- Prostaglandin analogs: Bimatoprost, latanoprost, and travoprost are among the most efficacious drugs for reducing IOP 6.
- Beta-blockers: Timolol, levobunolol, and betaxolol are commonly used beta-blockers to reduce IOP 5, 6.
- Carbonic anhydrase inhibitors: Dorzolamide and brinzolamide are examples of carbonic anhydrase inhibitors used to reduce IOP 5, 6.
- Alpha 2-adrenergic agonists: Brimonidine and apraclonidine are alpha 2-adrenergic agonists that can reduce IOP 5, 8.