Medication
A number of different types of medications are currently in use to treat glaucoma. If your doctor feels you will benefit from treatment with medication, they will work with you to find one that is appropriate for you. Your doctor may prescribe one medication or a combination of two or more medications to provide the most effective treatment for you. At times, finding the right medication for you can be a trial and error process since you may not respond to or may have side effects to some of the medications.
All glaucoma medications have the possibility of having side effects, although the potential side effects are different for each class of medication. Please let your doctor know of any side effects you are experiencing from the medication. It is possible to experience these side effects either initially or over a long period of time. Your doctor will work with you to find a medication that is the most comfortable for you.
Over time, the medications you are using may start to lose their effectiveness or the glaucoma can progress without your knowledge. For this reason, it is important to have regular checkups so adjustments to your treatment can be made by your physician before your condition worsens. Adjustments may include changing the drop you are using or using a different combination of drops that may be more effective in controlling the pressure in your eye. If using more than one eye drop at the same time, please be sure to leave a five minute gap between instillation of the two different eye drops, to ensure you do not wash out the previous eye drop.
You and your doctor will work together to determine the best medicines for you. Never change or stop taking your medications without consulting with your glaucoma physician.
The following is a list of different types of glaucoma medications and their possible side effects:
- Prostaglanding Analogues (teal caps)
- Beta-Blockers (yellow or light blue caps)
- Carbonic Anhydrase Inhibitors (orange caps)
- Alpha-Adrenergic Agonists (purple caps)
- Rho Kinase Inhibitors (white caps)
- Miotics (dark green caps)
- Combination Medications (dark blue caps)
PROSTAGLANDIN ANALOGUE
Prostaglandin Analogues are drugs that work to lower pressure in the eye by improving fluid drainage. These drops are powerful and require use only once per day (typically instilled in the evening).
Possible side effects:
You may experience some eye redness and irritation which should improve in 1-2 weeks. Other side effects may include darkening of the iris (colored part of the eye), increased eyelash growth, or darkening around the eyes. Sometimes these medications are contraindicated with CME, chronic herpetic eye disease, and uveitis.
Medications:
Xalatan (Latanoprost)
Travatan Z (Travoprost)
Lumigan (Bimatoprost)
Vyzulta (Latanoprostene Bunod)
Zioptan (preservative free – Tafluprost)
Iyuzeh (preservative free – Latanoprsot)
BETA BLOCKERS
Beta-blockers decrease pressure inside the eye by reducing the amount of aqueous fluid your eye makes. They are most effective when used in the morning. These drugs are widely used and are generally well tolerated; however, this medication can potentially have systemic side effects. Beta-blockers can change cardiac activity by decreasing the amount of blood the heart pumps out, which may reduce the heart rate. They can also cause constriction of the bronchial airways and are contraindicated in patients with known obstructive airway disease. If you have a low heart rate, low blood pressure, COPD, asthma, or emphysema be sure to make your doctor aware as they may avoid this class of medication.
Possible side effects:
This drop may lower your heart rate, lower your blood pressure, cause fatigue, or worsen asthma if you have it.
Medications:
Timolol (Timoptic)
Timoptic Ocudose (preservative free)
Istalol
Betimol
Betagan (levobunolol), Ocupress (carteolol)
Betoptic
Combigan (Brimonidine-Timolol) and Cosopt (Dorzolamide-Timolol) – combination medications
CARBONIC ANHYDROUS INHIBITORS
These medications are available as an eye drop and in pill form and are related to the sulfa group of drugs. If you have experienced a serious allergic reaction to a sulfa medication in the past, be sure to let your doctor know. Very often patients with a known sulfa drug allergy tolerate these glaucoma medications without issue. These medications reduce the amount of aqueous fluid the eye makes. The pills have a higher level of side effects than the drops. The pills may be used when other attempts to control the glaucoma have not worked adequately. The eye drop form of these medications has less severe side effects and can be used regularly as a long-term medication when necessary.
Possible side effects:
The drop form of this medication may cause stinging, burning, and an odd taste in the mouth.
The pill form of this medication may have side effects throughout the body including fatigue, tingling in the hands and feet, depression, frequent urination, anemia, kidney stones, loss of appetite, weight loss, diarrhea, nausea, and memory problems. Since these pills lead to a loss of potassium from the body fluids, some of these side effects can be avoided by keeping hydrated and using natural sources of potassium.
Medications:
Trusopt (Dorzolamide)
Azopt (Brinzolamide)
Cosopt (Dorzolamide-Timolol) – combination medication
PF Cosopt (preservative free – PF Dorzolamide-Timolol) – combination medication
Simbrinza (Brinzolamide-Brimonidine) – combination medication
Diamox (Acetazolamide) – pill
Neptazane (Methazolamide) – pill
ALPHA-ADRENERGIC AGONISTS
These medications are eye drops that decrease the production of aqueous humor as well as improving the drainage flow of fluid out of the eye. Brimonidine has been shown in experimental animal models of glaucoma to have a neuroprotective effect (preserve existing neural axons), although this has not yet been validated clinically.
Possible side effects:
This drop may cause burning or stinging upon instillation, allergic reaction (redness of eyes and lids with swelling), dry mouth, drowsiness, and dilated pupils.
Medications:
Alphagan P (Brimonidine)
Combigan (Brimonidine-Timolol) – combination medication
Simbrinza (Brinzolamide-Brimonidine) – combination medication
Iopidine (Apraclonidine)
RHO-KINASE INHIBITORS
These drops help lower IOP by increasing outflow of aqueous humor by reversing structural and functional damage at the trabecular meshwork. These drops also reduce production of aqueous humor and decrease episcleral venous pressure (EVP).
Possible side effects:
This drop may increase eye redness, cause eye irritation, and may cause sub-conjunctival hemorrhage. This medication can also cause corneal verticillata, although this is asymptomatic and does not typically reduce visual function.
Medications:
Rhopressa (Netarsudil)
Rocklatan (Netarsudil-Latanoprost) – combination medication
MIOTICS
These drops work by constricting the pupil as well as other internal muscles of the eye; as a result, there is an increased drainage of aqueous humor through the trabecular meshwork, reducing intraocular pressure. Constriction of the ciliary muscle pulls on scleral spur widening the pore size in the filter (trabecular meshwork) through which the eye fluid needs to pass for effective drainage.
These medications are rarely used as long-term glaucoma treatment, however, in conditions such as narrow angle glaucoma that is unable to be treated with peripheral iridotomy or cataract surgery in a timely manner they may be recommended. They are sometimes necessary in conjunction with a laser procedure.
Possible side effects:
Brow ache, headache, eye pain, dim vision (especially at night or in darkened areas such as movie theaters). In near-sighted individuals there is an increased risk of retinal detachment.
Medications:
Pilocarpine
Carbachol, Isopto Carbachol
Follow your treatment plan
It’s up to you to follow your treatment plan and have regular follow-up visits. These visits are usually scheduled every 3 months with testing. At follow-up visits, your doctor will check to see if your glaucoma is getting worse. Remember to report anything you believe may be a side effect of the medicine you are taking.
Don’t skip doses!
Take your medicine as scheduled. Skipping doses of your medicine may put your vision in danger and mislead your doctor. Be sure to tell your doctor if you’ve missed any doses.
With a chronic disease like glaucoma, it can be hard to remember to use medicines as directed. It may help to link taking medicine to the things you do every day like eating meals or brushing your teeth.
After evaluating your progress, your doctor may try changing your doses, switching medicines or changing other parts of your treatment to find the best results for you. Sometimes simple changes like adjusting your schedule to take your medicines at mealtimes or before bed can make your drug routine more comfortable.
Tips for Taking Your Glaucoma Medicine
- Ask your doctor to write down an exact schedule for taking your medicine, especially if you’re taking more than one.
- Ask your doctor what to do if you accidentally forget a dose. The instructions may be different depending on which medicines you are taking.
- Learn about the medicines you are taking and the best way to use them. Find out whether they need special handling, such as storing them in the refrigerator.
- If you take a combination of drops and ointments, always apply the drops first.
- Schedule your doses around your normal routine, such as when you wake up, when you eat meals, and when you go to bed at night.
- Keep your medicines in plain sight; it’s easier to remember to take them.
- Keep medicines in a clean place. For example, if you carry them in your purse, put them in a plastic zipper bag to keep them clean.
- Take your medicines with you when you’re away from home. If you’re checking luggage at the airport, keep your medicines with you in your carry-on or in your purse.
- If you forget a dose, do not automatically double your next dose.
- Instead, follow your doctor’s instructions on what to do.
- If you can’t remember whether you took your medicines, simply use one dose at your next scheduled time.
- Tell all of your doctors about all the medicines you are taking. Glaucoma medicines may interact with drugs prescribed for other conditions.
- Call your eye doctor if you notice any unusual changes in your eyes, your vision or the way you feel in general.
- Schedule regular checkups and follow through with them.
- Take care of yourself, your eyes and the rest of you along with them!
Eyedrop Tips
Guide to Using Eye Drops
Prescription eye drops for glaucoma help maintain the pressure in your eye at a healthy level and are an important part of the treatment routine for many people. Always check with your doctor if you are having difficulty.
Remember:
- Follow your doctor’s orders.
- Be sure your doctor knows about any other drugs you may be taking (including over-thecounter items like vitamins, aspirin, and herbal supplements) and about any allergies you may have.
- Wash your hands before putting in your eye drops.
- Be careful not to let the tip of the dropper touch any part of your eye.
- Make sure the dropper stays clean.
- If you are putting in more than one drop or more than one type of eye drop, wait five minutes before putting the next drop in. This will keep the first drop from being washed out by the second before it has had time to work.
- Store eye drops and all medicines out of the reach of children.
Steps for putting in eye drops:
- Start by tilting your head backward while sitting, standing, or lying down. With your index finger placed on the soft spot just below the lower lid, gently pull down to form a pocket.
- Let a drop fall into the pocket.
- Slowly let go of the lower lid. Close your eyes but try not to shut them tight or squint. This may push the drops out of your eye.
- Gently press on the inside corner of your closed eyes with your index finger and thumb for two to three minutes. This will help keep any drops from getting into your system and keep them in your eye, where they are needed.
- Blot around your eyes to remove any excess.
If you are still having trouble putting eye drops in, here are some tips that may help.
If your hands are shaking: Try approaching your eye from the side so you can rest your hand on your face to help steady your hand.
If shaky hands are still a problem, you might try using a 1 or 2 pound wrist weight (you can get these at any sporting goods store). The extra weight around the wrist of the hand you’re using can decrease mild shaking.
If you are having trouble getting the drop into your eye: Try this. With your head turned to the side or lying on your side, close your eyes. Place a drop in the inner corner of your eyelid (the side closest to the bridge of your nose). By opening your eyes slowly, the drop should fall right into your eye.
If you are still not sure the drop actually got in your eye, put in another drop. The eyelids can hold only about one drop, so any excess will just run out of the eye. It is better to have excess run out than to not have enough medication in your eye.
Having trouble holding onto the bottle? If the eye drop bottle feels too small to hold (in cases where a dropper isn’t used and the drop comes directly from the bottle), try wrapping something (like a paper towel) around the bottle.
You can use anything that will make the bottle wider. This may be helpful in some mild cases of arthritis in the hands.
Assistive devices are available to help you put in your eye drops.