What is the initial treatment for individuals experiencing symptoms of glaucoma?

From the Guidelines

The initial treatment for individuals experiencing symptoms of glaucoma typically involves prescription eye drops to lower intraocular pressure (IOP), with prostaglandin analogs such as latanoprost (Xalatan) 0.005% being the most frequently prescribed initial eye drops due to their effectiveness and once-daily dosing 1.

Key Considerations

• Prostaglandin analogs are considered first-line medications unless contraindications, cost, side effects, intolerance, or patient refusal preclude this 1.
• Beta-blockers like timolol 0.25% or 0.5%, used twice daily, may also be prescribed as an alternative or in addition to prostaglandin analogs 1.
• Other glaucoma medications include alpha 2 adrenergic agonists, topical and oral carbonic anhydrase inhibitors, rho kinase inhibitors, and parasympathomimetics 1.

Administration and Adherence

• Patients should apply eye drops as directed, being careful not to touch the eye with the dropper tip, and should wait at least 5 minutes between different eye medications 1.
• Regular follow-up appointments are essential to monitor pressure and adjust treatment as needed, as glaucoma is a chronic condition requiring ongoing management to prevent vision loss 1.
• Adherence to therapy is crucial, and fixed combination therapy may improve patient adherence by reducing the number of drops required for therapy 1.

Additional Therapies

• Laser trabeculoplasty is an alternative therapy to medications in patients with ocular hypertension, and cataract surgery in patients with ocular hypertension has also been shown to produce sustained pressure-lowering effects 1.

From the FDA Drug Label

For adjunctive treatment of: ... chronic simple (open-angle) glaucoma, secondary glaucoma, and preoperatively in acute angle-closure glaucoma where delay of surgery is desired in order to lower intraocular pressure. 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 initial treatment for individuals experiencing symptoms of glaucoma is 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 to consider:

• The dosage should be adjusted with careful individual attention to symptomatology and ocular tension.
• Continuous supervision by a physician is advisable.
• In some cases, intravenous therapy may be used for rapid relief of ocular tension in acute cases 2.

From the Research

Initial Treatment for Glaucoma Symptoms

The initial treatment for individuals experiencing symptoms of glaucoma typically involves pharmacological therapy.

• The mainstay of glaucoma treatment is topical beta-blockers, which are considered first-line drugs 3.
• Other options for initial treatment include prostaglandins, local carbonic anhydrase inhibitors (CAIs), and alpha2-adrenergic agents, such as brimonidine 3.
• Monotherapy with beta-blockers is often the first line of treatment, but if this is ineffective or causes adverse effects, a change to another monotherapy or combination therapy may be advised 3, 4.

Combination Therapy

• Combination therapy may be indicated when the target pressure for an individual patient cannot be reached with monotherapy 3.
• Beta-blockers can be combined with prostaglandins, topical CAIs, and miotics, and prostaglandins such as latanoprost can be combined with beta-blockers, adrenergic agents, local CAIs, and miotics 3, 4.
• However, combinations with brimonidine or local CAIs need further investigation 3.

Treatment Goals

• The goal of treatment is to reduce intraocular pressure (IOP) and slow disease progression 5, 6.
• Reduction of IOP is the only proven method to treat glaucoma, and treatment is usually initiated with ocular hypotensive drops 6.
• Laser trabeculoplasty and surgery may also be used to slow disease progression 6.