Professional paper
Current Management of Open Angle Glaucoma
Zdravko Mandić
Jadranka Koršić
Lovro Bojić
Abstract
In recent years, a large number of drugs have been developed for treatment of glaucoma with the increasing choices of alternative medications.
A wide choice of newer local agents is now available for the treatment of glaucoma, each with differing efficacy and side effects. New treatment options for reducing IOP provide an opportunity to improve both compliance and therapeutic results while at the same reducing the level of side effects seen with multiple conventional drug regimens. This drug review considers the mode of action and properties of the various treatments, followed by practical advice to offer patients about their medication. Clinicians need to understand, synthesize and use data about medications that have specific benefits and risks for their glaucoma patients.
Glaucoma is a progressive optic neuropathy characterized by optic disc cupping and concomitant characteristic visual field defects. The term glaucoma describes a number of different disorders that affect the eye, all of which culminate in the death of the retinal ganglion cells of the optic nerve and visual field defects intraocular pressure (IOP) lowering is still the mainstay of treatment, the goal of which is to preserve visual function for the remainder of patients lifetime, whilst optimizing the quality of life. Most of the drugs now used to treat glaucoma are primarily directed at lowering IOP. In sense they are like cholesterol lowering agents in that they are designed to manage the risk factors for the diseases which led to glaucoma, rather than its basic underlying cause.
The concept of target IOP is worth considering. At the onset of treatment, it is helpful to establish a target IOP at which further damage to the optic nerve is deemed unlikely to occur. Commonly this is a 20 to 30 per cent reduction from the IOP at which damage occurred. If the glaucomatous optic neuropathy is worsening during the course of treatment, the target IOP may need to be adjusted. Compliance tends to fall off as the number of medications and dosing instructions increases and therefore, it is well worth reviewing a patient's list of medications to determine if some of the newer agents on the market may allow consolidation of treatments. This review deals with open angle glaucoma where medical therapy is commonly the initial form of management.
Keywords
Hrčak ID:
15000
URI
Publication date:
1.11.2002.
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