Glaucoma Medications.

There are many types of medications that can be used for glaucoma, such as beta-blockers, miotics, and adrenergic agonists. These drugs work by either slowing the flow of fluid into the eye or by helping to improve fluid drainage. Medications can effectively stop the progress of the eye condition; however, as the eye develops tolerance to the medicine, it may be necessary to increase dosages as needed.
Medications for Glaucoma: An Overview
Glaucoma medicines are designed to either reduce pressure by slowing the flow of fluid into the eye or help to improve fluid drainage.

While these drugs can effectively stop the progress of glaucoma, increasing dosages may be needed as the eye develops tolerance to the medication.

Medications to treat glaucoma are serious medicine, not to be confused with over-the-counter eye drops for easing common eye irritations. In order to control the disease, glaucoma drugs are taken for life.

There are several different classes of medicine used for glaucoma (available in the form of pills or eye drops). Some of these classes of medications include:

•Beta-blockers
•Miotics
•Adrenergic agonists
•Carbonic anhydrase inhibitors.

Beta-Blockers
The most popular glaucoma medication, Timoptic® (timolol maleate) is a beta-blocker eye drop. Usually taken twice daily, beta-blockers decrease production of aqueous humor.

These medicines may have side effects on the nerves, digestion, vision, skin, respiration, and heart of some individuals. Side effects may include:

•Lowered pulse rate
•Lower blood pressure
•Worsening of asthma
•Fatigue
•Breathing problems.

Miotics
Timoptic has a century-old predecessor, pilocarpine, that requires more frequent use to do its job, increasing drainage of aqueous fluid in both open and closed angle glaucoma. Pilocarpine is a miotic, designed to increase aqueous fluid drainage. Because these glaucoma medications work by making the pupil smaller, they can result in dim vision and may increase the risk of cataracts.

Types of Glaucoma.

Secondary GlaucomaGlaucoma can occur as the result of an eye injury, inflammation, tumor or in advanced cases of cataract or diabetes. It can also be caused by certain drugs such as steroids. This form of glaucoma may be mild or severe. The type of treatment will depend on whether it is open angle or angle closure glaucoma.

Pseudoexfoliative Glaucoma
This form of secondary open angle glaucoma occurs when a flaky, dandruff-like material peels off the outer layer of the lens within the eye. The material collects in the angle between the cornea and iris and can clog the drainage system of the eye, causing eye pressure to rise.
Pseudoexfoliative Glaucoma is common in those of Scandinavian descent. Treatment usually includes medications or surgery.

Pigmentary GlaucomaA form of secondary open angle glaucoma, this occurs when the pigment granules in the back of the iris (the colored part of the eye) break into the clear fluid produced inside the eye. These tiny pigment granules flow toward the drainage canals in the eye and slowly clog them, causing eye pressure to rise. Treatment usually includes medications or surgery.

Who is at risk of developing glaucoma? How is it detected, and how is it treated?

FOR a moment, keep your eyes focused on the last word in this sentence. Without moving your eyes, could you see some of the area above, below, and on either side of this magazine? Most likely you could, thanks to what is known as peripheral vision. This ability makes you aware of that suspicious-looking person who is approaching you from the side. It helps you to sidestep objects on the ground and avoid bumping into walls as you walk. And if you drive a car, peripheral vision can alert you that a pedestrian has stepped off the curb.

But even as you read this page, your peripheral vision could slowly be disappearing—without your even realizing it. Worldwide, an estimated 66 million people are affected by a group of eye diseases collectively known as glaucoma. Of that number, over five million have become totally blind, making glaucoma the third-largest cause of permanent blindness. “Yet even in developed countries with public educational programmes that target glaucoma, half of the individuals with glaucoma remain undiagnosed,” states the medical journal The Lancet.

Glaucoma could steal up to 90 percent of your vision in one eye without your being aware of it. How is that possible? All of us have a naturally occurring blind spot at the back of each eye. This spot on the retina, where your nerve fibers join together to form the optic nerve, is devoid of light-sensing cells. You are unaware of this blind spot, however, because your brain has the ability to “paint in” the missing bits of the picture. Ironically, it is the brain’s ability to do this that makes glaucoma so insidious.

Dr. Ivan Goldberg, a leading Australian ophthalmologist, told Awake!: “Glaucoma is called the sneak thief of sight because it doesn’t give you any symptoms. The most common kind of glaucoma is slow and steady and, without any warning, causes damage to the nerve structure that connects the eye to the brain. Whether your eyes water or they don’t, whether they are dry or not, whether they see clearly to read and write or they don’t has nothing to do with glaucoma. You can have perfectly comfortable eyes and have very bad glaucoma.”
Detecting the Thief

Unfortunately, there is no single comprehensive test for glaucoma. Using a device known as a tonometer, an eye specialist may start by checking the fluid pressure in your eyes. The instrument is used gently to flatten the cornea, or front part of your eye. The amount of force required to perform this task is measured, and in this way the pressure inside your eye can be gauged. The eye specialist may also look for signs of glaucoma by using instruments that identify damaged tissue in the nerve structure that connects the eye to the brain. Dr. Goldberg says: “We see if the nerve fibers or blood vessels at the back of the eye are unusual in shape, because that can be an indication that nerves are being damaged.”

Glaucoma is also detected by visual-field testing. Dr. Goldberg explains: “A person looks into a bowl of white light, and there is a brighter white light that is shone at a little spot inside that bowl. The person responds by pressing a button when he or she can see the little white light.” Failure to recognize the white light when it is at the outer edge of your visual field could indicate glaucoma. New instruments are being developed that might simplify this rather tedious procedure.

Who Is at Risk?

Paul is a healthy man in his early 40’s. He says: “I went to the optometrist to be tested for a new pair of glasses, and during the visit he asked me if I had a family history of glaucoma. I did some investigating and discovered that both an aunt and an uncle had this condition. I was referred to an eye specialist, who confirmed that I had glaucoma.” Dr. Goldberg explains: “If your mother or father has it, your risk of getting glaucoma goes up three to five times. And if you have a brother or a sister with glaucoma, then your risk of getting it goes up between five and seven times.”

Dr. Kevin Greenidge of the Glaucoma Foundation in the United States highlights other risk factors, saying: “If you are over 45 and of African descent, or if you have any of these risk factors—family history of glaucoma, nearsightedness, diabetes, a previous eye injury or regular use of cortisone/steroid products—get your eyes tested every year.” Even if you have no risk factors and are under 45, the foundation recommends that you still have your eyes checked for glaucoma every four years. If you are over 45, you should have this checkup every two years.