Which medications are used in the treatment of low-tension glaucoma?

Updated: Jun 10, 2020
  • Author: Mitchell V Gossman, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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The goals of pharmacotherapy are to reduce IOP and morbidity and to prevent complications. The goal of therapy with IOP-lowering medications is for a reduction of at least 30%. Nonselective beta-blockers (eg, timolol maleate, levobunolol) are controversial because as visual-field progression is possibly due to secondary aggravated nocturnal arterial hypotension. [18, 19] A systematic review and meta-analysis of 15 randomized clinical trials studying IOP-lowering agents for treatment of normal-tension glaucoma determined that latanoprost, bimatoprost, and timolol were most effective. [20]

Medications for neuroprotection are as follows:

  • Calcium channel blockers - Less progression [21]

  • Betaxolol - Improved choroidal flow, better visual-field preservation

  • Dorzolamide - Increased retinal blood flow velocity in humans

  • Brimonidine - Increased retinal ganglion cell survival in rat optic nerve crush injury

Future medications include the following:

  • N -methyl-D-aspartate (NMDA) receptor antagonist (Memantine) - Prevents binding of glutamate and resultant calcium influx; blocks rat ganglion cells from glutamate toxicity in rats and blocks toxic level of glutamate in vitreous

  • Serotonin S2 receptor antagonist (Naftidrofuryl) - Arteriolar vasodilation, improved blood flow in Raynaud syndrome

  • Glutamate antagonists

  • Monoamine oxidase inhibitors (Deprenyl) - Neuroprotection in rat crush model

  • Neurotrophic factors (Neurotrophins) - Retard apoptosis in cell culture

  • Free radical scavengers - Ginkgo biloba extract scavenges free radicals and nitric oxide, improves blood flow (60-120 mg bid)

  • Cannabinoids (marijuana) - Reduces IOP with NMDA antagonist and antioxidant activity

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