Table of Contents
- What is glaucoma?
- How is glaucoma treated?
- Why prostaglandins are first-line treatments
- The lowdown on beta blockers
- How rho kinase inhibitors work
- What are nitric oxides?
- Using carbonic anhydrase inhibitors
- What to know about alpha-adrenergic agonists
- How miotic or cholinergic agents help glaucoma
- 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.