terminology and guidelines for glaucoma ii - Kwaliteitskoepel

Furthermore, blindness may occur despite treatment and individuals at appreciable risk of visual disability thus needing
rigorous management must to be identified. Consequently, physicians should be advised to consider more
aggressive treatment of IOP in patients suspected to have altered ocular blood flow 13 . In some patients, arterial hypotension,
either drug-induced or spontaneous, is a factor to be addressed with the internist.
Neuroprotection refers to the concept of protecting ganglion cells from early death due to endo- or exotoxins or
ischemia. Several experimental studies show the potential for this type of treatment in animal models on injury or in
vitro. This research does not yet apply to humans. Large clinical trials are under way and results will be avaiable
within 2-3 years.
A large proportion of patients with progressive glaucoma still remain undiagnosed until too late. To discover
and treat those at risk of losing functionally significant vision is a more preferable task than widespread treatment
of IOP per se.
It is important when selecting the medical treatment of glaucoma to understand not only the aims of therapy, but
also the mode of action, side effects and contraindications of each individual medication.
There are many antiglaucoma drugs available. The choice of therapy must take into account quality of life, cost and
compliance. Generally speaking, if more than two topical medications are required to control the IOP, then other
forms of therapy, such as laser trabeculoplasty or surgery, should be considered.
In many patients beta-blockers have been used as the first choice of therapy since they are effective and usually well
tolerated. Caution must be exercised if the patient suffers from a systemic condition such as bronchopulmonary
disease or cardiac arhythmia, since the systemic absorption of these drugs may cause relevant adverse systemic
effects. If the first choice medication alone does not control the glaucoma, then adjunctive therapy can be added to
the therapeutic regime. In any patient in whom topical beta-blockers are not indicated, any of the other topical
agents can be initiated as first time therapy. Some relevant findings of the randomized controlled trials are summarized
in Ch. Introduction II.
The following pages outline the most frequently used anti-glaucoma medications, and emphasize their mode of
action, dosage and side effects. They are to be considered as a general guide, and cannot be all-inclusive.
Ch. 3 - 4 EGS