Many drugs that are being used to lower and control IOP and thus slow down the progression of glaucomatous damage and vision loss. As with most drugs the side effects need serious consideration prior to prescription. Topical ocular use of FP-class PG analogs causes mild but protracted hyperemia; burning and stinging; iridial hyperpigmentation; orbital skin color pigmentation; and eyelash thickening and growth. The major side effect of topical ocular use of b blockers is transient stinging, burning, and some foreign body sensation. The systemic effects of these drugs are more pronounced and may include hypotension, bradycardia, palpitations, arrhythmias, and bronchospasms and other related pulmonary side-effects, and are thus contraindicated for asthmatic patients. Topical ocular b blockers may also cause CNS effects such as sleep disturbance, loss of memory and libido, depression, anxiety, and confusion. Pilocarpine and other muscarinic agonists, although much less prescribed nowadays, cause miosis, brow ache, and accommodative problems. Topical administration of carbonic anhydrase inhibitors can cause temporary but significant ocular surface discomfort, blurred vision, and a bitter taste, which sometimes limits their utility for treating ocular hypertension. Likewise, firstgeneration adrenoceptor agonists such as epinephrine cause brow ache, eye pain, headache, conjunctival hyperemia, and numerous systemic side effects, such as systemic hypertension and arrhythmias. Newer a2-agonists, e.g., brimonidine and apraclonidine, can cause an ocular allergy-type reaction, manifested as hyperemia, itching, tearing, foreign body sensation, and conjunctival edema. Other side effects of these latter drugs are taste aversion, dry mouth/ nose, headache, fatigue, lethargy, and sedation. Topical ocular use of hypotensive drugs and their side effects are discussed in detail elsewhere.1,2
Since some ocular hypertensive patients become refractory to treatment to some or all of the currently available drugs, there is a continuing need to discover new potent and efficacious drugs with reduced side effects. In addition, better surgical procedures and drugs that can render the latter more successful are still being sought.
Diagnosis of glaucoma has relied on short-wavelength automated perimetry (SWAP), frequency doubling perimetry (FDP),2 and multifocal visual evoked potential (MVEP) measurement, which represent psychophysical measurements of vision and visual fields, coupled with scanning laser polarimetry (SLP)2 and optical coherence tomography,2 which measure retinal nerve fiber layer thickness and optic nerve cupping. However, further advances in these techniques and simpler and more predictive genetic tests are still warranted to aid the diagnosis of glaucoma patients at earlier stages of the disease process.
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