Pharmaceutical Management of Glaucoma

Reviewing the Major Classes of Antiglaucoma Medication

Catherine M. Birt, MA, MD, FRCSC
Sunnybrook & Women's College
Health Science Centre,
Assistant Professor,
University of Toronto

Medical management of glaucoma is a field that has expanded dramatically over the past five or six years. Since aging is one of the major risk factors for the development of glaucoma, it is an area that is of great relevance to anyone managing geriatric patients. The purpose of this article is to review the five major classes of antiglaucoma medications, the drugs that are currently available in each class, their indications and their side effects.

Glaucoma is considered to be an optic neuropathy with characteristic optic nerve damage (with loss of the neuroretinal rim and an increased cup-to-disc ratio) and visual field changes (with arcuate field defects progressing to complete loss of peripheral vision). Intraocular pressure (IOP) is not part of the definition of the disease, as many people with statistically elevated IOP do not develop the neuropathy, and many patients with statistically normal IOP do. Intraocular pressure is considered a major risk factor for the development of glaucoma. Other risk factors include advanced age, race, positive family history, myopia, and systemic factors such as diabetes and hypertension. Glaucoma is generally divided into open versus closed angle, and each of these can be subdivided into primary and secondary subtypes.