Ep. 013: A Comprehensive Review of Glaucoma Medications with Karl Pappa, MD

Dr. Karl Pappa, a glaucoma specialist, joins Dr. Suh on this episode to discuss all aspects of glaucoma medications. Glaucoma, a disease of the optic nerve, is thought to be worsened by increased eye pressure. The goal of treatment, whether it be with eye drops, laser or surgery, is to lower the intraocular pressure (IOP).

Categories of Glaucoma Medications

• Prostaglandin analogs
  • Xalatan (latanoprost), Lumigan (bimatoprost), Travatan Z (travoprost), Zioptan (tafluprost), and Vyzulta (latanoprostene bunod)
  • How they lower pressure: increases the outflow of fluid
  • Dosing: once at bedtime
  • Main side effects: eye redness, iris color change, eyelash growth, darkening of eyelid skin
• Beta blockers
  • Timolol, Timoptic XE (gel-forming solution)
  • How they lower pressure: decreases production of fluid
  • Dosing: once or twice a day
  • Main side effects: low blood pressure, decreased pulse rate, fatigue, shortness of breath (in COPD and asthma patients), depression
• Alpha agonists
  • Alphagan P (brimonidine)
  • How they lower pressure: decreases production of fluid and increases drainage
  • Dosing: two or three times a day
  • Main side effects: allergy to the medication, fatigue/drowsiness, burning or stinging, headache, dry mouth
• Carbonic anhydrase inhibitors
  • Eye drops -Trusopt (dorzolamide), Azopt (brinzolamide)
  • Oral medications: Diamox (acetazolamide) and Neptazane (methazolamide)
  • How they lower pressure: decreases production of fluid
  • Dosing: twice a day for the drops; varies for the pills (follow instructions of your eye care specialist)
  • Main side effects: eye drops: stinging; pills: tingling of hands and feet, fatigue, stomach upset
• Rho kinase inhibitor
  • Rhopressa (netarsudil)
  • How they lower pressure: increases the outflow of fluid
  • Dosing: once at bedtime
  • Main side effects: eye redness, stinging, tiny hemorrhages on the white of the eye

Combination eye drops help with compliance and may be more economical. Examples include Cosopt (timolol/dorzolamide), Combigan (timolol/brimonidine), Simbrinza (brimonidine/brinzolamide), and Rocklatan (netarsudil/latanoprost).

One reason patients have decreased compliance is because they can get ocular surface irritation and dry eyes from repeated use of drops that contain preservatives such as benzalkonium chloride (BAK). Several preservative-free options include Zioptan, Cosopt PF, and Timoptic in Ocudose.

Several new drug delivery alternatives are being studied. The FDA recently approved Durysta (bimatoprost), a biodegradable sustained-release implant that is injected into the eye between the cornea and the iris. Obviously, compliance will not be an issue with this medicated implant but it will have to be replaced every few months.

After instilling a glaucoma drop into your eye, close your eyes for up to five minutes to maximize absorption into the eyes and minimize systemic absorption to avoid some of the side effects.

Here is another resource about glaucoma drops.

To learn more about Dr. Pappa and his practice, visit Arena Eye Surgeon's website or find the practice on Facebook.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.