ANTI-GLAUCOMA MEDICATION
The main objective of glaucoma treatment is to reduce eye pressure either through medication and/or surgery. As long as the patient experiences progression in glaucoma, the lower the pressure the better it is. Good uniform and regular pressure control are also considerations.
The making of a good anti-Glaucoma Drop:
But it has preservatives which have adversed effects. An eye drop has muiti-components:-
The making of a good patient with glaucoma using eye drops:
Good eyedrop profile:
The mechanism of treatment with eyedrops is via one or both of 2 processes:
1st line therapy: timoptol & prostaglandins <gold standards>
2nd line therapy: brimonidine & dozolamide
3rd line therapy: pilocarpine, pilogels
Preservatives: BAK or beozolkonium chloride commonly used The concentration used varies with different eyedrops. Less stable eyedrops may require more BAK (as much as 4 times other drops)
BAK causes disruption of tear film and patient experiences:
Most of the non-prescription eyedrops for dry eye have dropped BAK as a preservative.
Preservatives are essential because they:
Other preservatives are being introduced such as purite (an oxidising preservative sensitive to sunlight) and sofzia (composed of boric acid, propylene glycol, sorbitol and zinc chloride. )
Combination drugs -
<most of the combination eyedrops are combined with timolol>
From the Aging Eye (The Eye Digest): Glaucoma Treatment
NGC www.guideline.gov : Glaucoma
| SURGICAL TREATMENT
Surgical treatment of glaucoma are often classified:-
Benefits
Filtering is a procedure of choice.
Disadvantages:
Surgery may be further classified:
Trabaculectomy is most common surgery for glaucoma in Singapore - is still a first line surgery <gold standard> for many patients with POAG, pigmentary, exfoliation and chronic ACG.
Trabeculoplasty -
Canaloplasty - a filiament is inserted in the Schlemm's Canal and tied; the tension opens the canal allowing increased aqueous outflow
- considered investigational/ not medically necessary
Cycoldestructive - limits the production of aqueous humor by the destruction of some of the cillary body
Endoscopic cyclophotocoagulation
Cycolcryotherapy - using low temperatures (-112degF) to destroy cillary body.
Glaucoma is essentially a plumbing problem.
Glaucoma Valves & Shunts
- drainage devices and implants to aid filtration
Valve devices - "cut-off switch" to stop flow when a certain IOP is reached to prevent hypotony.
Area is about 200mm2 to 400mm2 for double plates
Currently available implants include:
Cataract Extraction
- more than we have realised, it lowers IOP. This chance to lower pressure makes it possible to improve vision. <Samuelson>
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Glaucoma Treatment |