Overview
Drug treatment for glaucoma aims to reduce intraocular pressure to protect the optic nerve. It relies on daily eye drops chosen from five main classes, each with a different mechanism of action.
- Most common form
- Eye drops or gels — given locally, with systemic effects reduced but not absent.
- Five main classes
- Prostaglandins, beta-blockers, carbonic anhydrase inhibitors, alpha-agonists, miotics.
- Aim
- Controlling intraocular pressure and protecting the optic nerve.
- Adherence
- Taking them at the prescribed times — this is the key to treatment success.
The 5 classes of medicines
Each class works differently to control eye pressure. The choice and combination depend on the stage of the disease, the patient's contraindications and the individual response to treatment. Many patients use fixed combinations (two medicines in the same bottle, so fewer drops to put in) and preservative-free eye drops, which are better tolerated by people with dry eye. In Europe, medicines from newer classes are also approved, such as Rho-kinase inhibitors.
- 01
Prostaglandin analogues
Usually the first choiceThese are the most effective medicines and, according to European Glaucoma Society guidelines, are usually the first choice. They need just one application a day (in the evening) and increase the outflow of aqueous humour through an alternative route called the uveoscleral pathway.
- 02
Beta-blockers (eye drops)
Alternative or add-onThey work by reducing the production of aqueous humour. They are an alternative when prostaglandin analogues are not suitable, or they are added to them when they are not enough on their own.
- 03
Carbonic anhydrase inhibitors
Eye drops or tabletsAvailable as both eye drops and tablets, they reduce the production of aqueous humour by acting on a specific enzyme.
- 04
Alpha-agonist medicines
Dual mechanismThey work both by reducing production and by increasing outflow of aqueous humour. A dual mechanism of action.
- 05
Miotics (eye drops)
Less often used todayAmong the first medicines used in treating glaucoma. They work by increasing the outflow of aqueous humour through the trabecular meshwork. They are effective, but need several applications a day and can cause difficulty seeing at night and with focusing (accommodation).
Management and monitoring
How well drug treatment works depends on using eye drops correctly and on regular check-ups. Two well-established habits make the difference between success and failure of treatment.
Using the drops correctly
To make the treatment as effective as possible, it is essential to follow a few basic rules. Applying eye drops requires good hand hygiene and the correct technique.
The medicine should be put into the lower conjunctival sac, taking care not to touch the eye with the dropper.
After applying the drops, gently close your eyes for 1-2 minutes and press the inner corner of the eye to reduce absorption into the rest of the body.
If you use more than one type of eye drop, wait at least 5 minutes between applications.
Monitoring the treatment
Successful treatment requires regular checks of eye pressure, the visual field and the appearance of the optic nerve. How often check-ups are needed is set by your ophthalmologist, based on how severe the disease is and how you respond to treatment.
Regular check-ups of eye pressure, visual field and optic nerve.
Eye pressure can vary during the day, so measurements at different times of day are sometimes needed.
How often check-ups are needed is set according to the severity of the disease and how you respond to treatment.
Side effects
Every medicine may cause side effects, ranging from mild local discomfort to possible systemic effects. It is essential to tell your ophthalmologist about any symptoms that appear after starting treatment.
Ongoing monitoring
Some side effects may lessen over time, while others may require a change of treatment. Careful, ongoing observation is key.
A personalised approach
Managing side effects is always tailored and takes into account the characteristics of each individual patient.
Never stop without consulting your doctor
Even if side effects occur, it is essential to discuss them with your ophthalmologist before making any change to the treatment. Changes made on your own can compromise control of intraocular pressure and speed up the progression of glaucoma.