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Glaucoma medications: the Optum Perks Guide

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There’s no cure for this eye disease. But there are lots of treatments that can help you keep your eyesight sharp.
Written by Rosemary Black
Updated on November 30, 2022

Table of Contents

  1. What is glaucoma?
  2. How is glaucoma treated?
  3. Why prostaglandins are first-line treatments
  4. The lowdown on beta blockers
  5. How rho kinase inhibitors work
  6. What are nitric oxides?
  7. Using carbonic anhydrase inhibitors
  8. What to know about alpha-adrenergic agonists
  9. How miotic or cholinergic agents help glaucoma
  10. Tips for taking glaucoma medications

The idea of going blind is scary. And for the 3 million Americans who have glaucoma, that’s a real possibility. If left untreated, glaucoma can damage your eyesight. Luckily, there are many ways to save it.

One way is to keep on top of yearly eye exams. The other is finding the right treatment if you’re diagnosed with glaucoma. There are many types of medications that can help.

But let’s start with the basics.

What is glaucoma?

It’s a group of eye disorders. The most common is called open-angle glaucoma. Other types include angle-closure glaucoma and congenital glaucoma.

No matter which type you have, the condition starts the same way. “The eye is kind of a natural pump system,” explains Rachel Lee, MD. She’s a glaucoma surgeon at New York Eye and Ear Infirmary of Mount Sinai Medical Center in New York City. “There is part of the eye that’s always making fluid. And there’s a part of the eye that’s always draining fluid.”

Doctors don’t know why the fluid stops moving normally in people with glaucoma. What they do know is that the fluid builds up and puts pressure on the optic nerve, says Dr. Lee. That’s the nerve that connects the back of the eye to your brain. Over time, the optic nerve gets damaged from so much pressure. That’s when your vision starts to worsen.

How is glaucoma treated?

Most of the treatments for glaucoma work in a couple of ways. They either help drain the fluid from the eye or stop it from producing so much fluid. “Think of it as a plumbing system with a faucet and a drain,” says Jennifer Stone, OD. She’s an optometrist at Levin Eyecare in Baltimore. “You can either turn the faucet down or open the drain wider.”

The treatments include prescription eyedrops, laser and/or surgery. But you may never need surgery.

That’s because medications for glaucoma are very effective, Stone says. “We sometimes use a couple of different types together. If the patient needs to avoid a certain class of medications, we can choose another,” she adds.

Here’s a rundown of available medications.

(No matter how you manage your glaucoma, Optum Perks wants to help you save at the pharmacy. Here’s how it works.)

Why prostaglandins are first-line treatments

Doctors typically start treating glaucoma with prostaglandin drops, says Alyssa Wozniak, PharmD. She’s an assistant professor at the School of Pharmacy at D’Youville University in Buffalo, New York.

Prostaglandins lower the pressure in your eye by helping the way the fluid drains, says Wozniak. Examples include Xalatan® (latanoprost), Travatan Z® (travoprost) and Lumigan® (bimatoprost).

Dr. Lee says they’re easier to use than other drops. You only need to put in the drops at bedtime.

These types of eyedrops can cause your eyelashes to grow thicker and fuller, Dr. Lee says. Not such a bad thing, right? But there are not-so-great side effects, too.

The skin around your eyes can darken, and so can your eye color if you have light-colored eyes, says Stone. You may also suffer from mild redness in the eyes, she says.

The lowdown on beta blockers

Beta blockers such as Betoptic S® (betaxolol),Betimol®, Istalol® and Timoptic® (timolol) reduce the amount of fluid your eye produces. That also decreases the pressure on the optic nerve.

Doctors also turn to them as a first choice for newly diagnosed patients, says Dr. Lee. But they’re not for everyone.

People with heart conditions shouldn’t take them because they can lower your heart rate. Neither should folks with asthma or chronic bronchitis because beta blockers can set off wheezing attacks. People with very low blood pressure should stay away from beta blockers, too, says Dr. Lee.

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How rho kinase inhibitors work

These eyedrops also increase the amount of fluid that drains from your eyes. But exactly how they do that isn’t well known, says Wozniak.

One example of rho kinase inhibitors is Rhopressa® (netarsudil). Rho kinase inhibitors are excellent at achieving low eye pressure, Stone says. In fact, she adds, research shows that they beat out some of the prostaglandins.

Rho kinase inhibitors do have drawbacks, though. First, they’re expensive, Wozniak says. Rhopressa is available only as a brand name medication. So there isn’t a less expensive generic version for it.

Rho kinase inhibitors also carry side effects. Usually, the eye gets irritated and even swollen. And the white part turns red. “Some patients don’t tolerate it as well as the prostaglandins,” says Stone.

That’s why doctors typically turn to Rhopressa only if other types of eyedrops aren’t lowering eye pressure, says Wozniak.

Recommended reading: 5 exercises that will help improve your eyesight.

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What are nitric oxides?

Nitric oxides are a relatively new treatment option. They help the fluid drain from your eye so that the pressure goes down. Vyzulta® is the only type available for now. It’s 2 medications in 1, explains Dr. Lee. It contains nitric oxide as well as prostaglandins.

“This is a good option for lowering eye pressure,” says Dr. Lee. Its side effects are similar to those of prostaglandin eyedrops, she adds. But it may be more expensive than other medications because there’s no generic version, notes Wozniak.

Using carbonic anhydrase inhibitors

Carbonic anhydrase inhibitors such as Trusopt® (dorzolamide) and Azopt® (brinzolamide) lower the pressure in your eye. But they don’t do it as well as other eyedrops, Wozniak says. Doctors will prescribe them if you can’t use other medications due to side effects or if you have certain health conditions, she explains.

Doctors might also add these drops to ones you already take. For example, if beta blockers aren’t lowering the pressure enough, your eye doctor may add a carbonic anhydrase inhibitor, Wozniak notes.

What to know about alpha-adrenergic agonists

Alpha-adrenergic agonists lower the amount of fluid your eye makes, says Stone. Examples include Iopidine® (apraclonidine) and Alphagan® P (brimonidine). “Iopidine is an older drug, and Alphagan P is newer,” she says. “They may be added on to other treatments.”

Some patients are allergic to alpha-adrenergic agonists. They may cause the eyelids to swell, she notes. It’s not a very common reaction, but it’s reversible. When you stop using the drops, the swelling goes away, she adds.

How miotic or cholinergic agents help glaucoma

Miotic or cholinergic agents such as Isopto® Carpine (pilocarpine) date to the 1960s and 1970s, says Stone. “They had some heavy side effects, so they’re not commonly used anymore,” she adds. Common side effects include:

  • Blurred or dim vision
  • Stinging, burning or discomfort in the eye
  • Itching or redness of the eye
  • Tearing or swelling of the eye
  • Headache

Some side effects are more serious, and you should call your doctor immediately. They include:

  • Sudden loss of vision
  • Sweating
  • Nausea
  • Vomiting
  • Diarrhea

This type of medication is still helpful for draining fluid from the eye, Dr. Lee says. “I prescribe pilocarpine to patients who want to explore all the possible treatment options before considering surgery,” she explains. “Or for very specific types of glaucoma.”

Tips for taking glaucoma medications

The hardest part of treating glaucoma? Remembering to use the drops every day. It’s especially tough if you take them 2 or 3 times a day. But stick to a routine.

“I remind patients that this condition doesn’t cause symptoms,” says Stone. “You won’t feel differently if you don’t take your medication. But if you miss a dose, your eye pressure will go right up.” And that means your eyesight will get worse.

To make it easier to remember:

  • Link the time you use eyedrops to something else you do every day, suggests Stone. Try it in the morning when you brush your teeth or with your first or second cup of coffee. Or at night when you watch TV.
  • Set timed reminders on your phone.
  • Get a calendar and make a mark every time you take the drops.

Recommended reading: How never to forget a dose of medication.

If you’re still missing doses, talk to your eye doctor. Don’t be embarrassed. Your provider may be able to suggest other medications that fit more easily into your routine. Just remember, your eyesight is precious. And saving it is top priority.

Additional sources:
Glaucoma basics: National Eye Institute
Understanding glaucoma: The Glaucoma Foundation
Overcoming glaucoma medication challenges: The American Academy of Ophthalmology