Treatment of glaucoma
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The eye condition of glaucoma is a public health issue of global concern. An estimated 6.7 million people are affected by this disease. Moreover, blindness caused by glaucoma is irreversible, unlike loss of vision from cataracts.

More alarming are the various research reports suggesting that health services in developed nations are aware of only 50% of the total count of people suffering from glaucoma. From this data, one can conclude that it is highly probable that the situation is even worse in the developing parts of the world.

Though a lot more research needs to done about the core pathogenesis of this disease, there has been sufficient progress in its therapeutic concepts. The process of reducing intraocular pressure (IOP) has proved to be most effective in checking the disease. Early detection of the condition is also vital in delaying blindness in glaucoma patients. Moreover, choosing the right kind of therapy for a particular case is also a complicated process, which involves a variety of factors.

Proper planning of a glaucoma therapy

Any practitioner must chalk out a therapeutic plan to ensure optimal results and minimum risks for the patient. Here are a few essential tips for a safe and successful glaucoma treatment:

  • Before a starting on the medication, a doctor must also be equipped with sound knowledge of the procedure behind the process to be implemented, its disadvantages, associated adversities etc.
  • Both the patient and the doctor should involve in a discussion about the pros and cons of the therapy according to the case at hand.
  • A detailed investigation about the patient’s general health, current medication, vulnerability to side effects and psychosocial factors must be conducted.
  • Every patient’s risk factors for glaucoma development must be evaluated vis-à-vis estimated life span. This assessment must take into account the patient’s intraocular pressure, age, ethnicity, family record and educational background.

The physician should also have some detailed knowhow about how to recommend medication by determining a baseline and a target intraocular pressure. The quality and quantity of medication must also be cautiously handled.

The intraocular pressure (IOP) control process

The process of lowering IOP with medication has been practiced for many years now. However, its effectiveness in the treatment of primary open-angle glaucoma (POAG) has been reported only very recently. There have been a number of studies like the The Early Manifest Glaucoma Trial (EMGT), Normal Tension Glaucoma Study, The Ocular Hypertension Treatment Study (OHTS), the Collaborative Initial Glaucoma Treatment Study (CIGTS) etc. that have reported the effectiveness of this therapy.

Intraocular pressure-lowering medication

There are over 25 varieties of glaucoma drugs, grouped into six board categories. Here is an overview of the drugs based on their means of action.

  • Prostaglandin analogues like latanoprost, bimatoprost, travoprost, isopropyl unoprostone etc.
  • Beta-blockers like timolol, betaxolol, levobunolol, metipranolol and carteolol.
  • Carbonic anhydrase inhibitors like acetazolamide, methazolamide, dorzolamide and brinzolamide.
  • Adrenergic agonists like epinephrine, dipivefrin, apraclonidine and brimonidine. Apraclonidine and brimonidine are more frequently administered now-a-days.
  • Hyperosmotic agents are applicable only in cases where topical medications and oral CAIs prove slow and ineffective in lowering IOP. The oral drug glycerol and isosorbide and intravenous drug mannitol are some hyperosmotic agents.
  • Parasympathomimetic/Cholinergic agents: They were the first administered glaucoma drugs and include the acetyl choline receptor agonist, pilocarpine, and the indirectly acting echothiophate iodide. Currently they are not so popular treatments due to their drawbacks in prolonged glaucoma therapy, especially their serious ocular side effects.
  • Combination therapy: A combination of drugs is one of the most potent ways to treat glaucoma. Almost 40% of glaucoma cases need to use more than one IOP-checking drug. In fact, it is a common strategy to use these combination drugs to decrease resistance and help in administration of the doses. Ideally, it should be for cases where monotherapy fails. Cosopt, xalacom, timpilo and extravan are the names of some of these combination drugs.

Treatment of glaucoma with neuroprotective agents

Reducing IOP cannot work in isolation in order to check glaucoma and lowering the risk of blindness. Since, optic nerve cupping (resulting from retinal ganglion cell death) and loss of axons occur simultaneously with physical alterations in the optic nerve, it is necessary to preserve the optic nerve as well. Though there are still more conclusive studies required for ascertaining the role of neuroprotective agents in glaucoma treatment, it is as of now available only as a part of research protocols. Some of the neuroprotective agents are mementine, calcium channel blockers, alpha-2 adrenergic agonists and beta-blockers.

Apart from a detailed knowledge of the indications and therapies of glaucoma, one needs to be abreast with the latest treatments town as well.

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