Skip to main content
MJH Life Sciences
  • Login
  • Register
  • Login
  • Register
Home
  • Topics
  • Refractive
  • Cataract
  • Glaucoma
  • Cornea
  • Retina
  • Practice Mgmt.
  • OTE
  • Job Board
MJH Life Sciences

SUBSCRIBE: Print / Digital / eNewsletter

The Magnificent 7: How many glaucoma medications are too many?

glaucoma
  • Lynda Charters
November 10, 2019
Volume: 
44
Issue: 
18
  • Glaucoma, AAO, Medication Adherence, Specialty Medications, Treatments

Abstract / Synopsis: 

Finding the sweet spot surrounding the number of anti-glaucoma medications translates to a balancing act with focus on individual patient needs. 

This article was reviewed by Janet B. Serle, MD

Ophthalmologists have the luxury of choosing from among seven current IOP-lowering medications, with doses that range from one to four times daily. The list includes prostaglandin analogs (PGAs), rho kinase inhibitors, beta-blockers, alpha-agonists, carbonic anhydrase inhibitors (CAIs), miotics, and non-selective adrenergic agonists. 

This may well be an embarrassment of riches, with the ready availability of these options raising interesting questions and prescribing quandaries for physicians.

Likely the most important question is what is the optimal tolerated, effective, and reasonable IOP-lowering regimen? Janet B. Serle, MD, pointed out during a presentation at the 2019 American Academy of Ophthalmology annual meeting.

Related: Looking behind IOP when managing glaucoma patients 

“We have a great deal of evidence-based facts about medical therapy,” she said. “We know that if a second, third, fourth, or more medications are added to a regimen, typically effective IOP reductions are not anticipated/obtained compared with when those medications are used as first-line interventions.” 

Dr. Serle, professor emeritus, Icahn School of Medicine at Mount Sinai, New York, noted that the duration of efficacy of a second, third, fourth, or more medications may be less and the efficacy tends to wane over time.

Other factors come into play that reduce patient compliance, such as regimen complexity, cost, side effects, age, physical infirmity, changes in mental status, education level, and health literacy. The nighttime efficacy is also less with some drugs, resulting in possible glaucoma progression. Inter-day and intra-day IOP fluctuations also can result in progression.

A study has suggested that combination therapy may actually reduce fluctuations. Chronic medical therapy causes changes in conjunctival tissue that may negatively impact incisional surgery, and chronic drug dosing contributes to ocular surface disease, Dr. Serle enumerated.

Related: Pearls to manage surgery patients on antithrombotic drugs 

Prescribing habits
While numerous caveats are related to the decisions to prescribe IOP-lowering medications, Dr. Serle noted that the question is what actually has been happening in medical practice.

A look-back at treatment practices shows a steady rise in the average numbers of medications prescribed over the past three decades. The average number in the Advanced Glaucoma Intervention Study in 1992 indicated that 2.7 drugs were prescribed.

This was prior to the advent of the PGAs, topical CAIs, and adrenergic agonists. When those drugs became commercially available, the average number of medications rose to 3.0 and 3.2 in major studies from the late 1990s to 2004.

By 2006, the average was 3.4, and the current regimens reported in peer review articles have included 3.6 medications; CME case reports have reported use of three to five medications in individual patients, Dr. Serle reported.

Related: Tonometry can serve as tool in CME prevention 

Pages

  • 1
  • 2
  • next ›
  • last »

Related Articles

Resource Topics rightRail

  • Resource Topics
  • Partner Content
  • Dry Eye Awareness
  • Ocular Surface Disease
  • Wet AMD
  • IOL Advances
  • Therapeutic Cataract & Refractive
Shifting The Paradigm for Retinal Disease Management: The Value of Modern Electroretinography
Video on CATALYS® Laser System presented by Johnson & Johnson
Video on WHITESTAR SIGNATURE® PRO System by Johnson & Johnson
CME Activities
DEXYCU® (dexamethasone intraocular suspension) 9% Case Study Series

Current Issue

Ophthalmology Times: December 2019
Dec 10, 2019 Vol 44 No 20
Digital Edition
Connect with Us
  • Column 1
    • Home
    • About Us
    • Contact Us
  • Column 2
    • Editorial Info
    • Editorial Board
  • Column 3
    • Advertising Info
    • Reprints
    • Advertising Terms
  • Column 4
    • Terms of Use
    • Privacy Policy
Modern Medicine Network
© UBM 2019, All rights reserved.
Reproduction in whole or in part is prohibited.

We've noticed that you're using an ad blocker

Our content is brought to you free of charge because of the support of our advertisers. To continue enjoying our content, please turn off your ad blocker.

It's off now Dismiss How do I disable my ad blocker?
❌

How to disable your ad blocker for our site:

Adblock / Adblock Plus
  • Click on the AdBlock / AdBlock Plus icon on the top right of your browser.
  • Click “Don’t run on pages on this domain.” OR “Enabled on this site.”
  • Close this help box and click "It's off now".
Firefox Tracking Prevention
  • If you are Private Browsing in Firefox, "Tracking Protection" may casue the adblock notice to show. It can be temporarily disabled by clicking the "shield" icon in the address bar.
  • Close this help box and click "It's off now".
Ghostery
  • Click the Ghostery icon on your browser.
  • In Ghostery versions < 6.0 click “Whitelist site.” in version 6.0 click “Trust site.”
  • Close this help box and click "It's off now".
uBlock / uBlock Origin
  • Click the uBlock / uBlock Origin icon on your browser.
  • Click the “power” button in the menu that appears to whitelist the current website
  • Close this help box and click "It's off now".