Glaucoma

Question 1

Targets for glaucoma treatment

Answer 1

Target IOP 25% lower than baseline or 30-50% for severe risk

Question 2

What are the non-pharmacologic treatments for glaucoma?

Answer 2

Laser trabeculoplasty - laser aimed at the trabecular meshwork
Trabeculectomy - Surgical removal of a portion of the trabecular meshwork
Cyclodestructive survery - trans-scleral laser reduces rate of aqueous humour production
Aqueous shunts - Drainage device
Laser Iridotomy - create a hole in the peripheral iris allowing aqueous humour to flow from posterior to anterior chambers

Question 3

What pharmacological treatment has the most efficacy?

Answer 3

Prostaglandins

Question 4

Give a 2 examples of prostaglandins and describe their mechanism of action

Answer 4

Latanoprost, bimatoprost.

They increase outflow of aqueous humour via the uveoscleral tract

Question 5

What is Timolol and how does it work in glaucoma? Name other drugs in this class that can be used for glaucoma

Answer 5

It is a beta blocker. They block sympathetic nerve endings to reduce aqueous humour production by the cilliary bodies. Betaxolol.

Question 6

What is the treatment for acute closed angle glaucoma?

Answer 6

This is a medical emergency. Treatment is laser iridotomy then pharmacological management.

Question 7

What are the drug classes that can be used in glaucoma? Give an example for each

Answer 7

Prostagladins - latanoprost, bimatoprost
Beta blockers - tinolol, betazolol,
Alpha blockers - brimanidine
Carbonic anhydrase inhibitors - brinzolamide

Question 8

What medications increase the risk of glaucoma?

Answer 8

Anti-cholinergics
TCA
SSRI