terminology and guidelines for glaucoma ii - Kwaliteitskoepel

Practical points for topical medical treatment 30,51
To minimize drainage into the nose or throat, patients should be instructed to use finger pressure exerted on the
medial canthus for a minute or two following installation of the eye drop. Excess solution around the eye should be
removed with a tissue and any medication on the hands should be rinsed off.
Many studies are available to compare the IOP lowering efficacy and the safety of topical preparations. Published studies
vary considerably in population sample, methodology, criteria for definition of the outcome, statistical analysis
graphics and overall quality, making very difficult to draw conclusions and comparisons. Meta-analysis is not available
for any of the drugs used for glaucoma treatment with the exception of beta blockers. The pre-post graph shown
below is a useful tool to show the IOP changes induced by treatment and its use should be encouraged in publications.
mmHg
Fig. 3.3 - THE PRE -POST IOP GRAPH
A simple graph can be used to show the IOP lowering effect. Different shapes/colors can be used to show different
patient series or different observation times. Vertical and horizontal lines show respectively Pre and Post
Treatment IOP levels of interest, here placed as examples at 15 and 21mmHg. Areas of desired effect under the
oblique “no effect” line can thus be defined.
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.
The text does not contain all the drugs, nor all their indications, contraindications and side effects but only the most
relevant ones. Before starting each treatment please carefully read the product information sheet.
For each drug category: Action, Dosage and Administration, Indications, Major contraindications, Major side effects,
Pregnancy and nursing mothers precautions, Drug interaction, Wash-out are summarized.
When more than one drug is referred to under any heading, these are listed in alphabetical order.
Ch. 3 - 8 EGS