Glaucoma Treatments and Medications

What is glaucoma?

Glaucoma is a group of eye diseases affecting the optic nerve. The common feature is progressive damage to the optic nerve caused by high eye pressure, which can lead to permanent blurry or dimmed vision and could lead to blindness, especially if not properly treated, according to the Cleveland Clinic.

Types of glaucoma

Glaucoma is typically caused by increased intraocular pressure (IOP) in the eye because fluids, called aqueous humor, do not drain properly. There are two main types of glaucoma.

• Primary open-angle glaucoma: This is the most common type of glaucoma. About 90% of people with glaucoma have open-angle glaucoma. There are rarely any early warning signs, and structures in the eye appear normal, but fluid does not drain properly.
• Chronic or acute angle-closure glaucoma: The remaining 10 percent of those with glaucoma have this type. The normal drainage passage is narrowed and becomes blocked so that fluid in the eye cannot drain.

• African-Americans over the age of 40
• People with a family history of glaucoma
• People who have diabetes
• People who have had serious eye injury in the past
• People who take corticosteroid medications
• All people over the age of 60
• People with hypertension

How is glaucoma diagnosed?

In the early and moderate stages of open-angle glaucoma, there are generally no symptoms. Some people may first notice a loss of peripheral vision, which might not occur until the disease has progressed. “Generally, glaucoma progresses very slowly over the years—so much so that it is sometimes called the sneak thief of vision; it can creep up on you without you knowing,” explains Kaushal M. Kulkarni, MD, a board-certified ophthalmologist with a private practice in New York City. “That said,” he further explains, “Any form of glaucoma that causes the intraocular pressure to shoot up can progress quickly.”

• Redness in eyes
• Vision in one or both eyes seems hazy
• Seeing halos around lights
• Narrowing of the visual field (loss of peripheral vision) called tunnel vision

• Intense eye pain
• Stomach upset or nausea
• Red-eye
• Blurry vision

Glaucoma treatment options

Treatment aims to lower the pressure in your eyes, reducing the risk of additional vision loss. Any vision loss you experienced before treatment is permanent. There are several different types of treatment for glaucoma, according to NEI-NIH.

Prescription medications

Prescription eye drops are usually the first line of treatment. Medicated eye drops lower pressure in the eyes by either promoting drainage of the fluid or reducing the amount of fluid. “Generally, once you start eye drops for glaucoma, you will need them the rest of your life,” Dr. Kulkami says.

Laser treatment and surgery

Laser trabeculoplasty is used for open-angle glaucoma and completed in your doctor’s office. During this procedure, a laser helps fluid drain out of the eyes and reduce pressure in your eye. You might see some swelling, experience eye irritation, or have blurry vision immediately after treatment. Most people return to regular activities the next day. Laser iridotomy treats narrow-angle glaucoma and chronic angle-closure glaucoma.

• Glaucoma implant surgery: This is used to treat several types of glaucoma and is done in the out-patient unit of the hospital. You go home the same day but will not be able to drive yourself home. A small tube or shunt is placed in the white of your eye to promote fluid drainage.
• Minimally invasive glaucoma surgery (MIGS): This is a new approach to treat glaucoma and is considered safer than implant surgery and allows you to recover faster. There are fewer complications than with implant surgery but might not be as effective. For this surgery, microscopic-sized equipment makes tiny incisions.

• Researchers at UC Berkeley and the University of Toronto have published findings they hope will lead to treatments that can halt the progression of glaucoma and lead to a cure.
• Catalyst for a Cure by the Glaucoma Research Foundation is bringing together experts in stem cell technology, neuroprotection, and nerve fiber regeneration to identify novel methods for reconnecting the eye and restoring vision in those who have lost it.
• The National Eye Institute is funding several studies to better understand what causes fluid pressure to increase in the eyes to better understand the cause and find ways to prevent and treat it.

Glaucoma medications

There are two main categories of drugs for glaucoma. The first reduces pressure by increasing drainage. The second reduces the amount of fluid in the eye. Both work to lower eye pressure.

Drugs used to increase fluid drainage

Prostaglandin analogs

• Xalatan (latanoprost)
• Travatan (travoprost)
• Lumigan (bimatoprost)
• Rescula (unoprostone)
• Timolol
• Tafluprost

Rho-kinase inhibitor

Rhopressa (netarsudil ophthalmic solution) is a medication introduced in 2017. These eye drops reduce pressure in the eyes by improving the outflow of the trabecular meshwork. Most drugs today target the secondary drainage system, the uveoscleral pathway, or reduce fluid. Rhopressa targets the primary drainage system. Years ago, some medications treated the meshwork, but they had severe side effects. People with normal or slightly elevated pressure where current medications are limited in their ability to lower pressure in these patients can also use this medication.

Miotic or cholinergic agents

• Isopto (carbachol)
• Isopto Carpine (pilocarpine)

• Betoptic, Betoptic S (betaxolol)
• Ocupress (carteolol)
• Betagan (levobunolol)
• OptiPranolol (metipranolol)
• Betimol (timolol hemihydrate)
• Timoptic, Timoptic-XE (timolol maleate)

Alpha-adrenergic agonists

These are sometimes used after laser surgery to prevent a sudden increase in pressure.

• Iopidine (apraclonidine)
• Alphagan, Alphagan-P (brimonidine tartrate)

Carbonic anhydrase inhibitors

Your healthcare provider might suggest these when other drugs have not been effective. Some might come in pill form, but these are rarely used due to their adverse effects.

• Neptazane (methazolamide)
• Daranide (dichlorphenamide)
• Azopt (brinzolamide hydrochloride)
• Trusopt (dorzolamide hydrochloride)

Combination medications

• Combigan (timolol, brimonidine tartrate): This medication is a combination of brimonidine and timolol and reduces pressure by increasing drainage and decreasing the amount of fluid in your eye. Side effects include burning, dry, itchy eyes, discharge from eye, redness, pain, swelling of eye or eyelid, stinging in eye, and tiny bumps on the lining of the eyelid.
• Cosopt (dorzolamide, timolol maleate): This medication is a combination beta-blocker and anhydrase inhibitor. The generic form of this medication is available.

What is the best medication for glaucoma?

There are many choices of treatments for glaucoma, but there is no "best" medication. What works for one person might not work for another. Your eye doctor will take your type of glaucoma, medical condition, medical history, and other medication you are taking into consideration when suggesting a treatment for you.

• Redness, itching or burning in the eyes
• Feeling as if something is in the eye
• Blurred vision
• Darkening of eye color
• Decreased pupil size
• Changes in night vision
• Watering eyes or discharge from eyes.
• Respiratory problems
• Lowered heart rate and blood pressure
• Odd taste in the mouth
• Pain or swelling of eye or eyelid

What are the best natural remedies for glaucoma?

Glaucoma is a serious eye disease that can lead to blindness if not treated. It requires medical attention and treatment. There are no natural remedies to treat or cure glaucoma. There are, however, some things you can do that might reduce your risk of developing glaucoma or reduce eye pressure.

• Limit caffeine: Caffeine may raise eye pressure. Although not statistically significant, caffeine can slightly increase intraocular pressure, according to the AAO.
• Exercise regularly: A study published in Medicine & Science in Sports & Exercise suggests physical exercise could reduce the risk of developing glaucoma by 40 percent or more.
• Sleep with your head elevated: Raising your head slightly while sleeping might reduce intraocular pressure, according to a study published in Eye. Another study found that sleeping with protective eyewear significantly reduced intraocular pressure.

• Lutein and zeaxanthin can be found in green, leafy vegetables and eggs and might reduce the risk of chronic eye diseases
• Vitamin C, found in citrus fruits, might reduce the risk of cataracts
• Vitamin E, found in nuts and fortified cereals, protects cells in eyes
• Zinc helps bring vitamin A from your liver to your retina to produce melanin which is a protective pigment in the eyes

Which eye drops are used to treat glaucoma?

There are five major types of eye drops used to treat glaucoma. These are:

• Prostaglandin analogs
• Rho-kinase inhibitor
• Beta-blockers
• Carbonic anhydrase inhibitors
• Alpha agonists

What is the first sign of glaucoma?

Many people don’t notice symptoms in the early stages of glaucoma. The narrowing of the visual field, called tunnel vision, is often the first sign people notice, which can be after the disease has advanced.

Can glaucoma be stopped?

There is no cure for glaucoma currently; however, researchers are currently looking for a cure. Treatment can slow down or halt the progression of the disease but cannot reverse any loss of vision that has already occurred.

What foods to avoid if you have glaucoma?

Consuming caffeine in moderation is probably a good idea. Caffeine can cause a rise in intraocular pressure for about 90 minutes after consumption. However, it is not sure if this is significant in the development of glaucoma. There is little evidence that avoidance of any other foods will prevent glaucoma.

Are there any natural remedies for glaucoma?

Glaucoma is serious and untreated, and it can lead to permanent blindness. While there are things you can do at home to lower your risk level, there isn’t any proven alternative treatment. It is best to see an ophthalmologist.

How dangerous is glaucoma?

Glaucoma can lead to vision problems, such as dimmed or blurry vision. Without proper treatment, it can lead to permanent blindness.

Related resources for glaucoma

• Save money on glaucoma prescriptions with the SingleCare app
• Medical management of glaucoma: A primer
• Exciting new treatments for glaucoma
• Comparative effectiveness of treatment for open-angle glaucoma