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What You Should Know About...
Medical Treatment for Open Angle Glaucoma

Primary open angle glaucoma, which is sometimes called chronic glaucoma, is the most common type of glaucoma.  According to the Glaucoma Research Foundation, this type of glaucoma affects about three million Americans.   It is called “open angle” because the drainage angle between the iris and cornea are open, but the fluid is not draining properly.  There is a blockage somewhere in the drainage system, similar to a clog in your kitchen sink.  Since your eye is continuing to create fluid faster than it is draining out, your intraocular pressure becomes elevated.  Over time, this elevated pressure will damage your optic nerve. 

The first step in minimizing the vision loss associated with glaucoma is to control your intraocular pressure.  And, the first step in this treatment is the use of topical eye medications.   Your treatment plan will evolve as your condition changes. So, you should understand that once you’ve been diagnosed with glaucoma, you will need to be treated for the rest of your life.

Using Eyedrops

The first step in treating glaucoma is usually medicated eyedrops. There are various types of eyedrops and your ophthalmologist will prescribe what is appropriate for your condition and overall health. Your doctor must also be aware of all your medications – both prescription and over the counter. This is important to ensure that there is no negative interaction between the eye drops and your other medications.  Because herbal medications can also interact with medications, please make sure you tell your doctor if you are taking any herbal supplements.

The most important thing for you to remember is that you must use these eyedrops exactly as they are prescribed.  Missing even a few doses can cause the damage to your optic nerve to increase.  It is possible that you may require more than one type of drop, and if so, you must understand when and how to use the drops correctly.

The National Eye Institute recommends that you follow these directions to increase the medicine’s effectiveness and reduce side effects:

  1. Wash your hands.
  2. Hold the bottle upside down.
  3. Tilt your head back.
  4. Hold the bottle in one hand and place it as close as possible to the eye.
  5. With the other hand, pull down your lower lid to form a pocket.
  6. Place the prescribed number of drops into the lower eyelid pocket.
  7. If you are using more than one eyedrop, be sure to wait at least five minutes before applying the second eyedrop.
  8. Close your eye and press the inner corner of the lower lid lightly with your finger for at least one minute. This prevents the drops from draining into your tear duct, which can increase the risk of side effects.

Types of Eyedrops

There are several types of eyedrops which are effective in controlling glaucoma.  Certain drops work by inhibiting the production of fluid in your eye, while others work by improving the outflow.  In some cases, it may be necessary for you to use both types.  Your doctor will prescribe the type of medication most appropriate for you – based upon the severity of your glaucoma, your overall health, as well as other medications you are taking.

  • Beta blockers such as Betagan and Betimol reduce the production of fluid.  Because possible side effects include difficulty breathing, these are not recommended if you have asthma, bronchitis or emphysema, or if you use insulin for diabetes.
  • Alpha-adrenergic agents such as lopidine and Alphagan also reduce the production of fluid.  Possible side effects include fatigue, dizziness, red, itchy or swollen eyes, and dry mouth.
  • Carbonic anhydrase inhibitors such as Trusopt and Azopt are another type of drop that reduces fluid. Possible side effects can include frequent urination and tingling in the fingers and toes. These are not recommended if you are allergic to sulfa drugs.
  • Prostaglandin analogues such as Xalatan, Lumigan and Travatan increase the outflow of fluid, and are sometimes used in conjunction with a drug that reduces the production of fluid.  Possible side effects include mild reddening and stinging of the eye, and darkening of the iris. Changes in the pigment of the eyelid skin may also occur, along with blurred vision.

Other, less common types of medications may also be used to control glaucoma.

Oral Medications

For some patients, eyedrops alone may not be enough to bring your intraocular pressure down.  If this is the case, you may be prescribed an oral medication similar to Azopt or Trusopt.  These medications are from a class of drugs known as carbonic anhydrase inhibitors, and decrease the production of fluid in your eye.

These pills can have some side effects including tingling or loss of strength in your hands and/or feet, upset stomach, fatigue, and frequent urination – particularly when you start taking the medication.  To minimize these effects, taking the pills at mealtime will help.  In addition, the Mayo Clinic recommends adding bananas and apple juice to your diet to minimize loss of potassium.

If you are having trouble with your eyedrops or medications, please talk to your doctor.  There are many options available today and we want to find what works best for you.

The most important thing for you to remember is that glaucoma often has no symptoms – until it becomes more advanced.  So, you may be tempted to stop using your eyedrops or taking your medications.  This is the worse thing you can do!

As long as the eyedrops and medications are controlling your eye pressure, you must continue to take them to prevent damage to your optic nerve.  This is why we have you come in for regular screenings – so that we can monitor your pressure.

Glaucoma can’t be cured.  It can be controlled – but only if you do your part by using your eyedrops and taking your medications exactly as they are prescribed.

Diet, Exercise and Dietary Supplements

Eating a well-balanced diet, especially one rich in fruits and vegetables, is good for your overall health.  Make sure that you also take the FDA’s recommended daily intake of the following vitamins, all of which promote eye health:

  • Vitamin A - 5,000 International Units
  • Vitamin C - 60 milligrams
  • Vitamin E - 30 International Units
  • Zinc - 15 milligrams
  • Copper - 2 milligrams

Regular exercise may reduce intraocular pressure in patients with open angle glaucoma.  However, some types of exercise may result in increased pressure.  You should be particularly cautious of any exercise, such as yoga, which puts your head in a downward position.

You should also be extremely cautious about using herbal supplements.  Herbal supplements are being promoted as a treatment for glaucoma.  However, there is no clinical research to substantiate these claims.  In addition, herbal supplements – which are unregulated and not subject to approval by the FDA, have been shown to have adverse  affects on the eyes.

"Herbal medicines and nutritional supplements are being used without strong evidence of efficacy or safety. Ocular side effects from these products are often undiagnosed and unreported," said Frederick W. Fraunfelder, M.D., a researcher at Oregon Health & Science University.  Therefore, you should exercise caution in using herbal medications.  In addition, since they can also have a negative interaction with medications and anesthesia, please make certain you tell your doctor of any herbal supplements you take.

Overview of Glaucoma
Open Angle Glaucoma
Medical Treatment for Open Angle Glaucoma
Laser Treatment for Open Angle Glaucoma
Surgery for Open Angle Glaucoma
Narrow Angle Glaucoma
Laser Treatment for Narrow Angle Glaucoma
Neovascular Glaucoma
Inflammatory Glaucoma