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Eye Matters

Intraocular pressure---Glaucoma

As new aqueous flows into your eye, balancing amount should drain out. This process maintains pressure in your eye balanced. But if the fluid builds up because of several reasons, pressure inside the eye called introcular pressure increases resulting in the optic nerve damage. 

Glaucoma medications:


Prostaglandin analogs increase the drainage of fluid from the eye. These include:

1. Xalatan® (latanoprost), 
2. Travatan Z® (Travoprost), 
3. Lumigan® (bimatoprost), and 
4. Zioptan™ (tafluprost). 

Beta blockers such as timolol are the second most often used class of medications that work by decreasing production of fluid. 

Alpha agonists decreases production of fluid and increases drainage.

1. [Alphagan®P (brimonidine), Iopidine®] 
2. Alphagan P has a purite preservative that breaks down into natural tear components and may be better tolerated in patients allergic to preservatives.

Carbonic anhydrase inhibitors (CAIs) decrease the production of intraocular fluid. These are available as 
Eye drops 
1. Trusopt® (dorzolamide), 
2. Azopt® (brinzolamide)] 

Oral capsules:
1. Diamox (acetazolamide) and
2. Neptazane® (methazolamide). 
Except for Azopt, all CAIs are available in generic form.

Combined medications are available for patients who need more than one type of medication. 1. Cosopt® contains a combination of a beta blocker (timolol) and a carbonic anhydrase inhibitor (dorzolamide) and is available in generic form and also as a preservative-free formulation (Cosopt® PF). 

2. Combigan® an alpha agonist (brimonidine) with a beta blocker (timolol). Simbrinza® is a beta blocker-free combination medication, It has brinzolamide and brimonidine.


Point 1: 

Travoprost (0.0015% and 0.004%), a highly selective, potent prostaglandin F receptor agonist, is equal or superior to latanoprost and superior to timolol in lowering intraocular pressure in patients with open-angle glaucoma or ocular hypertension. In addition, travoprost 0.004% is significantly better than either latanoprost or timolol in lowering intraocular pressure in black patients. Travoprost is safe and generally well tolerated in the studied patient population. ( 2001 Oct;132(4):472-84.)

Point 2: 

Mean IOP changes from baseline for travoprost 0.004% and latanoprost 0.005%/timolol 0.5% fixed combination were not significantly different at follow-up in these patients. Both medications were well tolerated. ( 2006 Mar;28(3):332-9.)

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