Symptoms
Glaucoma is a progressive eye disease that is initially asymptomatic. Patients have no symptoms until the optic nerve becomes increasingly damaged, which can lead to irreversible visual impairment with visual field loss and blindness. Glaucoma represents the most common cause of blindness.
Causes
The cause of the disease is usually an increase in intraocular pressure (ocular hypertension). This increase results from obstruction of aqueous humor outflow in the trabecular meshwork and damages the optic nerve. It is also referred to as primary open-angle glaucoma (other forms of glaucoma exist). Risk factors include age, black skin color, a family history of the disease, and nearsightedness. Primary open-angle glaucoma can rarely develop without an increase in pressure!
Diagnosis
Diagnosis is made in ophthalmologic care based on, among other things, measurement of intraocular pressure (>21 mm Hg) and eye examination. Normal values range from 10 to 21 mm Hg. Regular checks of intraocular pressure are recommended from the age of 40.
Nonpharmacologic treatment
- Laser treatment
- Surgical procedure
Drug treatment
The goal of treatment represents a reduction in intraocular pressure to prevent the visual disturbances and blindness and stop the progression of the disease. For this purpose, the so-called antiglaucomatous agents are administered. These are usually eye drops that reduce intraocular pressure through various mechanisms. They lower the production of aqueous humor or improve its outflow. Although the drops are used locally on the eye, adverse effects and drug-drug interactions can occur that affect the whole organism. The carbonic anhydrase inhibitor acetazolamide (Diamox) is used perorally in tablet form. Numerous combination preparations of the various active ingredients are commercially available, and generic versions are sometimes available: Prostaglandin analogs:
- Latanoprost (Xalatan).
- Tafluprost (Saflutan)
- Travoprost (Travatan)
- Bimatoprost (Lumigan)
Beta-blocker eye drops:
- Betaxolol (Betoptic S)
- Carteolol (Arteoptic)
- Levobunolol (Vistagan)
- Timolol (Timoptic)
Carbonic anhydrase inhibitor:
- Dorzolamide (Trusopt).
- Brinzolamide (Azopt)
- Acetazolamide (Diamox, Glaupax) – peroral
Sympathomimetics:
- Apraclonidine (Iopidine).
- Brimonidine (Alphagan)
Parasympathomimetics:
- Pilocarpine eye drops (Spersacarpine).
Rho kinase inhibitors:
- Netarsudil
Combination drugs
