NHMRC Glaucoma Guidelines - ANZGIG

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NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 9 – Medication Table 9.9: Safety of glaucoma medications during lactation (AMH 2009) Medication class Beta-blockers Alpha 2 -agonists Carbonic anhydrase inhibitors Prostaglandin analogues Cholinergics Unlikely to cause adverse effects at usual doses. Timolol listed as compatible with breastfeeding by the American Academy of Pediatrics. No data available, unlikely to be of concern. Monitor infant for adverse effects. No human data regarding topical carbonic anhydrase inhibitors. Acetazolamide listed as compatible with breastfeeding by the American Academy of Pediatrics. No data available, but unlikely to be of concern. Latanoprost is safe to use. Safe to use. Evidence Statements • Evidence supports using beta-blockers in pregnancy, but with caution due to the risks of foetal bradycardia and interuterine growth restriction. • Evidence supports laser therapy over surgical techniques in women who are pregnant or planning to conceive in the near future. point of note The Working Committee notes that treating pregnant women with glaucoma is always difficult and health care providers may have their own preference regarding treatment. The information presented in this guideline should allow health care providers to make an informed decision based on the current best evidence. Other vulnerable patients Glaucoma is a chronic disease that requires long-term management. However, unlike other chronic diseases, patients may be initially symptom-free. Furthermore, patients must be highly dexterous to master the instillation techniques required in common topical medication management strategies. This means that certain groups of patients may have to rely on others for assistance. All these aspects make it likely that some people suffering from glaucoma may experience challenges with maintaining their medication regimens, which may impact on the successful management of their disease. There is a paucity of information regarding the management of glaucoma in elderly patients such as those in nursing homes and aged care facilities. For example, beta-blockers have been shown to increase the risk of falls in the elderly (SEAGIG 2003). More research may be available to inform subsequent revisions of this guideline. point of note Vulnerable patients may have particular difficulty in adhering to the sustained medication regimens required for glaucoma management. An individual’s capacity to adhere to a medication regimen should inform clinical decisions regarding appropriate management strategies, and the need to organise patient support services. National Health and Medical Research Council 135
NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 9 – Medication References Adis International (2004): Corticosteroids are the main culprits in drug-induced glaucoma. Drugs Therapy Perspective; 20(8): 19-22. American Academy of Ophthalmology [AAO] (2005a): Primary angle closure preferred practice pattern. San Francisco: American Academy of Ophthalmology. American Academy of Pediatrics Committee on Drugs (2001): The transfer of drugs and other chemicals into human milk. Pediatrics; 108:776-89. American Optometric Association [AOA] (2002): Optometric clinical practice guideline: Care of the patient with open angle glaucoma (2nd edn.). St Louis: American Optometric Association. AMH (Australian Medicines Handbook Pty Ltd)(2009): Australian Medicines Handbook. Australian Medicines Handbook Pty Ltd Briggs GG, Freeman RK (2005): Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk (7th edn). Lippincott Williams & Wilkins: Philadelphia, Pa. Burr JM, Mowatt G, Hernández R, Siddiqui M, Cook J, Lourenco T, Ramsay C, Vale L, Fraser C, Azuara-Blanco A, Deeks J, Cairns J, Wormald R, McPherson S, Rabindranath K, Grant A (2007): The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technology Assessments; 11(41): 1-206. Chung CY, Kwok AK, Chung KL (2004): Use of ophthalmic medications during pregnancy. Hong Kong Medical Journal; 10(3): 191-195. Coppens G, Stalmans I, Zeyen T and Casteels I (2009): The Safety and Efficacy of Glaucoma Medication in the Pediatric Population. Journal of Pediatric Ophthalmology & Strabismus; 46;(1):12-18. Costa VP, Harris A, Stefansson E, Flammer J, Krieglstein GK, Orzalesi N, Heijl A, Renard JP, Serra LM (2003): The effects of antiglaucoma and systemic medications on ocular blood flow. Progress in Retinal & Eye Research; 22(6): 769-805. European Glaucoma Society [EGS] (2003): Terminology and guidelines for glaucoma (2nd edn.). Savona, Italy: European Glaucoma Society. Holman H, Lorig KR (2000): Patients as partners in managing chronic disease. British Medical Journal; 320: 526-527. Japanese Glaucoma Society [JGS] (2004): Guidelines for glaucoma. Tokyo: Japanese Glaucoma Society. Li J, Tripathi R, Tripathi B (2008): Drug-Induced Ocular Disorders. Drug Safety; 31(2): 127-141. Lorig KR, Holman H, Sobel DS, Laurent D, Gonzalez V, Minor M (2000): Living a healthy life with chronic conditions. Bull Publishing Co. Lorig KR, Sobel DS, Stewart AL, Brown BW, Bandura A, Ritter P, Gonzalez VM, Laurent DD, Holman HR (1999): Evidence suggesting that a chronic disease self-management program can improve health status whilst reducing hospitalisation: a randomised trial. Medical Care; 37: 5-14. Moore W, Nischal KK (2007): Pharmacologic management of glaucoma in childhood. Pediatric Drugs; 9(2):71-79. 136 National Health and Medical Research Council
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NHMRC Glaucoma Guidelines - ANZGIG

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