The goal of currently available glaucoma therapy is to preserve visual function by lowering intraocular pressure (IOP) below a level that is likely to produce further damage to the nerve. The treatment regimen that achieves this goal with the lowest risk, fewest adverse effects, and least disruption of the patient's life, taking into account the cost implications of treatment, should be the one employed.
The more advanced the glaucomatous process on initial presentation, the lower the target range generally needs to be to prevent further progression. This more aggressive target is meant to minimize the risk of progressive glaucoma damage and vision loss. Once the optic nerve is damaged, it is more likely to incur more damage, and if severe visual loss is present, there is greater impact on the patient from any additional damage that may occur.
An initial reduction in the IOP of 20% from baseline is suggested. However, reduction of IOP to the target pressure range does not guarantee that progression will not occur. Therefore, the target pressure range needs to be constantly reassessed and changed as dictated by IOP fluctuations, optic nerve changes, and/or visual field progression.
Medications are divided into several groups based on chemical structure and pharmacologic action. Agents in common clinical use include:
Fotil is a combination drug consisting of: