Therapeutic Review: Glaucoma - Compliance & Common Side Effects
This topic is extremely important to the successful management of your patients. As ocular therapeutics becomes more & more common amongst optometrists, it will be our responsibility to educate our treated patients on how to use their medications effectively and to be aware of the possible side effects that could occur.
Compliance with any medication needs constant monitoring by the prescribing and co-managing practitioner. One of the simplest things to implement is to maximise the absorption of any topical medication. I request that upon instillation of the eye drop the patient keeps their eyelids closed and that they refrain from blinking for at least one minute. This achieves two things:
- The drop is not flushed out of the eye through the puncta and stays in contact with the eye.
- It minimises systemic absorption and therefore minimises systemic side-effects. This is especially important with beta blockers like Timoptol, which can affect breathing and heart rate.
The lipid-receptor agonists are probably the first choice in treating glaucoma these days. They are usually the first choice because of the safety profile, their effectiveness in reducing IOP and because they are only required to be used once a day, therefore improving compliance.
Lipid receptor agonists that are prescribed are:
- Xalatan(Latanoprost), Travatan(Travoprost), Lumigan(Bimatoprost)
Common side effects are:
- Conjunctival hyperaemia
- Increased iris pigmentation
- Eye lash growth
Less common side effects are:
- Anterior uveitis and cystoid macula oedema
It is important to be aware of the possible side effects that can affect your patients. You will not only improve the success of the treatment but also impress the patient. Often practitioners do not go to the trouble of educating. It is not uncommon that the prescribing ophthalmologist has not discussed the issues related to the medication. I am then perceived as the more important practitioner, as I have diagnosed the condition, referred them for treatment and then explained the treatment.
Next month I will discuss the Beta Blockers and the side effects to watch out for.
Glaucoma deserves a whole days seminar. Register for Glaucoma 2005 or for Ocular Therapeutics 2006 , which will comprehensively cover its management and the implementation of procedures and instrumentation to make it a very profitable component of your clinical practice.