EP #19: Vision's Vanguard: Understanding the Potency of Glaucoma Medications

Have you ever wondered how a few tiny drops can be a game-changer in the fight against glaucoma? This episode promises to demystify the treatments that are crucial for managing this sneak thief of sight. Your host Dr. Thuy Nguyen, along with Jeremy Wolf, delve into the pharmacological frontlines of glaucoma therapy, emphasizing the role of eye drops in reducing intraocular pressure.

We journey through the complexities of prostaglandin analogs—the go-to warriors for many practitioners—while addressing the potential inflammation concerns for certain patients. The discussion also branches out into beta blockers like timolol, unpacking their effectiveness and safety considerations for individuals with respiratory issues. It's not just clinical jargon; Jeremy chimes in with personal stories about his father-in-law's struggles with glaucoma, highlighting the profound impact of early detection and diligent treatment. This episode is an essential guide for anyone touched by glaucoma, looking for clarity and hope in their vision care journey.

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Episode Transcript

Speaker 1 (00:03):
Welcome to the Jazzy Eyes podcast.
Taking care of your vision withexpert precision.
Here's your host, dr Tui Nguyen.

Jeremy (00:14):
Hello everyone, welcome back to the Jazzy Eyes podcast.
Jeremy Wolf here joined by yourhost, dr Tui Nguyen.
We have been on a glaucoma tear.
It is Glaucoma Awareness Monthand we were talking all about
glaucoma.
Dr Falco was talking aboutprimary glaucoma.
You got into a little bit aboutsecondary glaucoma on the
previous segment.

(00:34):
So what's on the agenda forthis segment, dr Nguyen?

Dr. Nguyen (00:38):
So I wanted to talk about like pharmacological drops
or medications that weprescribe to manage glaucoma.
In this one there are.
So glaucoma is a build of apressure in the eyes, so these
drop target to lower thepressure in the eyes.
Either it opens up the drainagepathway of the eyes or it

(00:58):
reduces or decreases productionof fluid in the eyes, all of
which can decrease pressure inthe eyes.
When we prescribe these dropsto you, the goal is to reduce
the pressure by 25 to 30%, andthen we see you back in about
two weeks after prescribingthese drops to see if you know,
the pressure is reduced by thatmuch.
There are three major classesof drops that I wanted to talk

(01:24):
about, one being the first linedrop that most practitioners
prescribe in myocococoma, andthey're called prostaglandin
analogs, short in.

Jeremy (01:35):
PGA Everything has such a complicated name in this.

Dr. Nguyen (01:40):
I like the abbreviations better the
acronyms.
That's what everyone abbreviatesanything that's more than two
syllables.
So prostaglandin analogs, orPGA.
They're prescribed andgenerally used once a night,
every night.
They're the most efficientbecause they usually, on average
, lower the pressure about 30%.
They are they work by promotingor opening up drainage pathways

(02:06):
in the eyes, and so they openup the pores or make the pores
bigger by relaxing muscles, andwhen the muscles relax, the
pores just naturally open up toallow fluid to pass through.
The only issue with the PGA isthat they're pro-inflammatory by
nature, and so we don't give itto those who are already
experiencing inflammatory eyeconditions, such as inflammatory

(02:29):
glaucoma that we talked aboutin the previous podcast.
There's also another class ofglaucoma drops.
They're called beta blockersand they a most common beta
blocker is called timolo.

Jeremy (02:43):
Beta blocker drops Beta blocker drops.
I've had them in pill formbefore.

Dr. Nguyen (02:47):
Yes, yes they are all beta blocks.
Yeah, and so funny that youmentioned that.
So timolo is an eye drop that'sused.
They usually use about twice aday.
Not as efficient as PGA's butstill pretty good 25% reduction
in the pressure.
They're usually people cautionto prescribe them and those with

(03:09):
asthma or COPD, because theycan cause decrease in
respiration.
Now, the systemic absorption ofeye drops is very low and so
people aren't too.
It's not too too high of a riskthat you're going to have
respiratory decrease whenprescribing these eye drops.
But if you are taking orals,that's something that more

(03:31):
people are more cautioned about.
So they do come in orals, butwe're not as concerned with
systemic absorption when itcomes to drops, but we do want
to keep in mind that we mightwant to give it to someone with
asthma or COPD.

Jeremy (03:45):
Man, you guys really are a wealth of knowledge when it
comes to this stuff.
Yes, so much good information.
I got to get these episodesover to my father-in-law.
Yeah, father-in-law, he hasglaucoma, oh yeah.
And he's blind as a bat.

Dr. Nguyen (04:04):
Yeah, yeah.
So when we catch early we'reable to slow down or prevent any
vision loss.
Too late for him now, I think.

Jeremy (04:12):
He's approaching 80 and he's been wearing like super
thick contact lenses for a whilebecause nothing works about
those.
But I'm sure he'll get a kickout of listening to all this
stuff.

Dr. Nguyen (04:23):
anyway, oh yeah, Very informational.
It's a whole month justdedicated for glaucoma.
And so there's one lastcategory of medication for
glaucoma and it's calledcarbonic anhydrase inhibitor.
Otherwise, you know what?
I'm saying there's another onethere's two more.

Jeremy (04:43):
Excuse me.
Oh, my goodness, I'm coming offa pretty nasty illness.

Dr. Nguyen (04:49):
I can't stop coughing, I know Okay.

Jeremy (04:52):
Please proceed, sorry, yes, so see, don't mind me.
Don't mind me.

Dr. Nguyen (04:56):
As you're dying over there.
Caas are another class of dropsthat are used to manage
glaucoma.
It's not used as often becauseit's not as efficient.
It lowers the pressure by 18,20%.
They're usually used incombination with another class,
but they contain sulfa, and sowe caution to prescribe this

(05:18):
medication in those who havesulfa allergies.
Caaas are also available inoral form, but they're not used
as often because of the seriousside effects.
They leave a metallic taste inthe mouth and so that's very
unpleasant, and they can alsocause tingly in the hands and
feet, which is why we don't usethem in oral form as often,

(05:40):
unless there is a very highpressure spike that needs to be
lowered right away in office.
Then we throw whatever we canat it to get the pressure to go
down.

Jeremy (05:50):
I really want to get into a whole another segment
maybe not with you guys, butjust somebody in general about
the whole metallic taste in themouth due to medications,
because I've had that beforefrom some other medications.
It's such a strange thing andI'm curious to learn about why
and how that happens.
Obviously not right now, butmaybe that's a topic for a

(06:11):
future discussion.

Dr. Nguyen (06:13):
I know it's such an unpleasant side effect.

Jeremy (06:15):
Yeah, it's just so interesting that you get a
metallic taste in your mouthfrom very much.

Dr. Nguyen (06:19):
Yeah, like, how does that happen, right?
I mean that's it.

Jeremy (06:24):
All right, well, let's wrap it up there, unless there
is something else you want toshare, but I know we got a lot
of information out there today,so I think we're good there.

Dr. Nguyen (06:34):
The most major glaucoma drops that most
practitioners will put you on tohelp manage glaucoma.
They can be used as standalonetreatments or in combinations
with each other, but those arethe most used in managing
glaucoma.

Jeremy (06:46):
All right, sounds good, dr Newell.
Until next time.
Have a wonderful day, have awonderful week and I will see
you soon.
Thank you To our listeners.
Thanks as always for tuning inand we will catch you next time.
Everyone take care, cool.

Speaker 1 (07:03):
Thank you for listening to the Jazzy Eyes
podcast.
For more information, visitjazzyeyescom or contact
954-473-0100.