If you ask a fellow optometrist for his or her preferred treatment for glaucoma, the usual response will be drops first, then surgery if necessary. However, as surgical techniques continue to become safer and more effective in treating glaucoma, the option of surgery first is becoming an earlier consideration for some patients.
This trend of surgery as first-line treatment is already prevalent in Europe, where many countries have a socialized health-care system. Cost is a major factor, as it is considerably less expensive to perform surgery so that all drug treatment can be stopped (although this is not always the case). Compare this to the total cost of glaucoma drugs over years--and even decades--of use.
Historically, medical therapy has been the treatment of choice. Glaucoma was first treated in the mid-1800s with pilocarpine.
During the past two centuries, however, many medical and surgical procedures, mainly involving the control of intraocular pressure, have been developed to treat the glaucomas.
These advances to control IOP in primary open-angle glaucoma (POAG) include better surgical techniques and more effective topical drugs that have fewer side effects and drug interactions.
This article considers available data from studies investigating these questions regarding the effectiveness of using either glaucoma medication or surgery.
In the United States, topical eye drops are the typical medical treatment today for POAG. These drugs fall into the categories of adrenergic beta receptor blockers, carbonic anhydrase inhibitors (CAIs), prostaglandin and prostamide analogues, and adrenergic alpha-2 receptor agonists. All of these drugs can present with local side effects, such as burning, redness of the conjunctiva and local allergic reactions.
* Beta-blockers. Beta-blockers include several nonspecific blockers and one beta-1 specific blocker, betoxalol, which generally has less risk of pulmonary effect than the non-specific blockers. These drugs are usually effective, with up to 30% reduction of IOP possible. Their mechanism of action reduces aqueous production at the ciliary body.
Side effects of beta-blockers include dangerous pulmonary airway obstruction, particularly in asthmatic patients who demonstrate acute reactive airways, and reduction in heart rate, which can lead to bradycardia and even complete heart conduction blockade.
Other reported side effects include male impotence, depression and dangerous interaction with calcium channel blockers.
The occurrence of serious side effects is rare as long as one is cautious in prescribing beta-blockers, particularly in the case of asthmatics. Timolol has been used as the standard medical treatment …