First-line glaucoma therapy

Optometric Management,  May 2000  by Thimons, J James,  Litwak, Anthony B

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Little more than 20 years ago, optometrists could barely diagnose glaucoma, let alone treat it. Today, optometrists in 44 states can treat, and more and more optometrists are taking advantage of this opportunity.

Our understanding of glaucoma is rapidly evolving. Concepts like cell apoptosis and neuroprotection are changing the way we look at glaucoma and starting to impact the way we treat it.

Our diagnostic ability, which was once limited to taking pressure measurements with a MacKayMarg tonometer, has advanced to affordable nerve fiber layer analysis and more accurate and reliable tests of visual field function. Our treatment armamentarium is also at a high point, with more effective and easier-to-use medications available than ever before.

Glaucoma was one of the first ocular diseases to be recognized yet, thanks to constant improvements in understanding, diagnosis and treatment, it remains on the cutting edge for optometrists. This article, the first part of two, reviews many of the latest developments with a focus on patient management from an experts' perspectives. It's my hope that it helps you better serve your patient's needs.

Art/bur Epstein, O.D., EA.A.O. Roslyn, MY hould we use newer medications such as latanoprost (Xalatan), brimonidine tartrate (Alphagan), and the topical carbonic anhydrase inhibitors as first-line therapy before topical beta blockers?

Beta blockers are generally well tolerated and are your most cost-effective option for lowering intraocular pressure. [Examples: betaxolol (Betoptic S), carteolol (Ocupress), levobunolol (Betagan), metipranolol (OptiPranolol), timolol maleate (Timoptic).] We use them as first-line therapy for most glaucoma patients, unless contraindicated.

If a patient reports even a mild contraindication (i.e., shortness of breath), then we avoid beta blockers and use latanoprost or brimonidine tartrate as a first-line therapy.

Beta blockers have potential systemic side effects; avoid using them for patients with certain pulmonary or cardiac problems. However, you can screen for potential contraindications by taking a careful history, reviewing current medications and taking a resting pulse and blood pressure.

With any glaucoma medication, it's important to educate your patient about possible adverse reactions as well as the reason they need the drops.

The benefits of the drops aren't immediately apparent, so patients need to understand why they're important. GLAUCOMA SCREENING a Have you ever considered starting a glaucoma screening program in your community? If so, Roger Martin, director of community outreach for a Norwalk, Conn., ophthalmology practice is the person you should contact.

In conjunction with the Lions Eye Health Program, Mr. Martin has organized screening for more than 1,800 people. His goal is to create a free national glaucoma screening program with help from eye health associations and product manufacturers around the country.

To contact him, leave a voice mail message at (203) 874-9449 or you can reach him via e-mail at lehpmartin@juno. com.

BY J. JAMES THIMONS, O.D., AND ANTHONY B. LITWAK, O.D. Fairfield, Conn., and Baltimore, Md.

Dr. Thimons is the director of Ophthalmic Consultants of Connecticut. Dr. Litwak is residency program director at the Dept. of Veterans Affairs of the Maryland Health Care System in Baltimore, Md.

Copyright Boucher Communications, Inc. May 2000
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