Glaucoma medical therapy : principles and management

313 Pages·2007·5.11 MB·English

Glaucoma Medical Therapy
Ophthalmology Monographs
A series published by Oxford University Press in cooperation with the
American Academy of Ophthalmology
Series Editor: Richard K. Parrish, II, MD, Bascom Palmer Eye Institute
American Academy of Ophthalmology Clinical Education Secretariat:
Louis B. Cantor, MD, Indiana University School of Medicine
Gregory L. Skuta, MD, Dean A. McGee Eye Institute
1. Retinal Detachment: Principles and Practice, third edition
Daniel A. Brinton and Charles P. Wilkinson
2. Electrophysiologic Testing in Disorders of the Retina, Optic Nerve, and Visual Pathway, second edition
Gerald Allen Fishman, David G. Birch, Graham E. Holder, and Mitchell G. Brigell
3. Visual Fields: Examination and Interpretation, second edition
Thomas J. Walsh
4. Glaucoma Surgery: Principles and Techniques, second edition
Edited by Robert N. Weinreb and Richard P. Mills
5. Fluorescein and Indocyanine Green Angiography: Technique and Interpretation, second edition
Joseph W. Berkow, Robert W. Flower, David H. Orth, and James S. Kelley
6. Magnetic Resonance Imaging and Computed Tomography: Clinical Neuro-Orbital Anatomy
Jonathan D. Wirtschafter, Eric L. Berman, and Carolyn S. McDonald
7. Cataract Surgery and Intraocular Lenses: A 21st-Century Perspective, second edition
Edited by Jerry G. Ford and Carol L. Karp
8. Volumes 1, 2, and 3, Surgery of the Eyelid, Orbit and Lacrimal System
Edited by William B. Stewart
9. Surgical Anatomy of the Ocular Adnexa: A Clinical Approach
David R. Jordan and Richard L. Anderson
10. Optic Nerve Disorders, second edition
Edited by Lanning B. Kline and Rod Foroozan
11. Laser Photocoagulation of the Retina and Choroid (with slide set)
James C. Folk and Jose´ S. Pulido
12. Low Vision Rehabilitation: Caring for the Whole Person
Edited by Donald C. Fletcher
13. Glaucoma Medical Therapy: Principles and Management, second edition
Edited by Peter A. Netland
14. Diabetes and Ocular Disease: Past, Present, and Future Therapies, second edition
Edited by Ingrid U. Scott, Harry W. Flynn, Jr., and William E. Smiddy
15. HIV/AIDS and the Eye: A Global Perspective
Emmett T. Cunningham, Jr., and Rubens Belfort, Jr.
16. Corneal Dystrophies and Degenerations
Edited by Ming X. Wang
17. Strabismus Surgery: Basic and Advanced Techniques
Edited by David A. Plager; written by Edward G. Buckley, David A. Plager, Michael X. Repka,
and M. Edward Wilson; contributions by Marshall M. Parks and Gunter K. von Noorden
www.oup.com/us/aao/plager/strabismus
18. A Compendium of Inherited Disorders and the Eye
Elias I. Traboulsi
www.oup.com/us/aao/traboulsi/genetic
GLAUCOMA
MEDICAL THERAPY
Principles and Management,
Second Edition
Edited by
PETER A. NETLAND, MD, PhD
Published by Oxford University Press
In cooperation with
The American Academy of Ophthalmology
1
2008
1
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Copyright Ó 2008 by Peter A. Netland
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Library of Congress Cataloging-in-Publication Data
Glaucoma medical therapy : principles and management / edited by Peter A. Netland.—2nd ed.
p. ; cm. — (Ophthalmology monographs ; 13)
Includes bibliographical references and index.
ISBN 978-0-19-532850-9
1. Glaucoma—Chemotherapy. I. Netland, Peter A. II. American Academy
of Ophthalmology. III. Series.
[DNLM: 1. Glaucoma—drug therapy. 2. Intraocular Pressure—drug effects.
W1 OP372L v.13 2007 / WW 290 G550152 2007]
RE871.G554 2007
617.7'41061—dc22 2007013167
9 8 7 6 5 4 3 2 1
Printed in China
on acid-free paper
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in this monograph.
Some material on recent developments may include information on drug or de-
vice applications that are not considered community standard, that reflect indica-
tions not included in approved FDA labeling, or that are approved for use only in
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Peter A. Netland, MD, PhD (left), and Robert C. Allen, MD (right), Memphis,
Tennessee, 2000.
Preface
n the latter part of the nineteenth century, effective medical treatment for
glaucoma was championed by physicians who had studied under Albrecht von
I Graefe. In 1876, Ludwig Laqueur, a professor in Strasbourg, France, recom-
mended the use of an extract of the calabar bean, the seed of an African vine that is a
source of physostigmine. At about the same time, Adolf Weber, a practicing oph-
thalmologist in Darmstadt, Germany, advocated the use of an extract of jaborandi,
a South American shrub that contains pilocarpine. Although these drugs did not
treat the underlying cause of glaucoma, they successfully controlled intraocular
pressure in many patients. Miosis-inducing parasympathomimetic drugs remained
the mainstay of medical therapy for glaucoma for the next 75 years, until the in-
troduction of oral acetazolamide and topical epinephrine in the 1950s, followed by
topical ophthalmic beta blockers in the 1970s.
In recent years, a large number of drugs have been developed for the treatment of
glaucoma. With the increasing choices of alternative medications, miotic drugs,
acetazolamide, and epinephrine are now less frequently used to treat chronic glau-
coma. Prostaglandin analogs, topical carbonic anhydrase inhibitors, and adrenergic
agonists have played an increasingly important role in the medical therapy of
glaucoma.While naturally available substances provided the earliest glaucomamed-
ications, new drugs are now developed through computational and synthetic che-
mical techniques. Currently available glaucoma medications have been approved
for clinical use based upon their ability to lower intraocular pressure, although
medications are being considered with other primary mechanisms of action that are
thought to be potentially beneficial in glaucoma therapy. The clinical use of drugs
for glaucoma therapy has evolved, adapting with the advent of each new drug.
viii Preface
Clinicians need to understand, synthesize, and use data about medications that have
specific benefits and risks for their glaucoma patients.
An ideal drug would have no side effects, would be effortless to administer,
would cost nothing, and would be 100% effective in controlling or eliminating the
problem. Currently, the ideal drug for glaucoma does not exist. Nonetheless, in-
vestigators continually strive to improve glaucoma medical therapy, which will
likely continue to improve in the future. New experimental and clinical investiga-
tions are promising and may open new therapeutic targets for treatment of glau-
coma in the future. The focus of this book is the current art and science of clinically
available drugs for medical therapy of glaucoma. The contributors have attempted
to provide evidence-based information about the topic, while providing perspective
from clinical experience.
This is a peer-reviewed, edited, multiauthor book, with chapters contributed by
individuals with expertise in the medical therapy of glaucoma. The book is intended
to provide information about glaucoma medical therapy for practicing ophthal-
mologists and ophthalmologists in training. Other practitioners who have clinical
contact with glaucoma patients also may find the content of this monograph valu-
able. The material in this book on the medical management of glaucoma comple-
ments the surgical orientation of the second edition of Glaucoma Surgery: Princi-
ples and Techniques, edited by Robert N.Weinreb, MD, and Richard P. Mills, MD,
and published by the American Academy of Ophthalmology and Oxford University
Press.
In the second edition of this book, all chapters have been thoroughly revised and
updated, and new chapters regarding fixed-combination drugs and medical treat-
ment in pregnancy and pediatric patients have been added. Some chapters have
required addition of extensive new material because of the changes in medical
therapy of glaucoma since the publication of the first edition of the book in 1999. In
2005, Robert C. Allen, MD, co-editor for the first edition, succumbed to the com-
plications of uveal melanoma. He was an esteemed clinical colleague and investi-
gator, prolific academic, respected department chair, devoted family man, and
cherished friend.
The contributors to this edition of Glaucoma Medical Therapy have dedicated
their efforts to the memory of Dr. Robert C. Allen (1950–2005).
Peter A. Netland, MD, PhD
Educational Objectives
The educational objectives of this monograph are to
Identify the different categories of drugs and combinations of drugs used to
treat glaucoma
Outline the treatment regimens employed with specific medications
Describe the side effects and contraindications of specific medications
Demonstrate how different drugs may be used either alone or in combination to
achieve the desired therapeutic effect
Provide updated information on medications and their role in glaucoma ther-
apy
Familiarize the reader with the effect of systemic medications on intraocular
pressure
Explain the use of osmotic drugs in the management of angle-closure glaucoma
and secondary glaucomas
Educate the reader on the use of medications in specific types of glaucoma, such
as pediatric, pigmentary, corticosteroid-induced, and neovascular glaucoma
Encourage the reader to monitor patient compliance with recommended regi-
mens and offer suggestions to improve compliance
Define maximum tolerable medical therapy
Analyze the use of medications in conjunction with laser or filtration surgery