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    Beyond IOP in glaucoma treatment

    Intraocular pressure (IOP) is only the starting point for glaucoma treatment. Successful treatment begins with establishing an IOP goal, but there are multiple considerations that affect treatment choices.

    “We currently have an array of medications that we can use to try to treat our glaucoma patients,” said Robert Stamper, MD, professor of ophthalmology and director emeritus  of the glaucoma service at the University of California, San Francisco. “It is pretty clear from the 24-hour proficiency in lowering IOP, both in amount and duration, that prostaglandins are our treatment of choice. But there are reasons to avoid them.”Robert Stamper, MD, explored the considerations that go into drug selection for glaucoma. Dr. Stamper pointed out that it is easy to forget that the patient with glaucoma likely has other medical problems and is taking other medications. (Photo by Stevan Nordstrom)

    Dr. Stamper explored the considerations that go into drug selection during a session on “Glaucoma Medications: Beyond IOP.” None of the factors that should influence drug selection are new, he said, but it is easy to forget that the patient with glaucoma likely has other medical problems and is taking other medications.

    “You want to maximize treatment safety by using as few medications as possible, matching medications to your patient’s needs and being cognoscente of what other medications your patient may be taking,” he said.” Keep the treatment regimen as simple as possible and watch for quality-of-life issues. In glaucoma, as in any condition, make sure the benefits of therapy outweigh the risks. We have many good choices and well over 90% of patients will benefit from drug treatment.”

    Treatment should begin with the lowest possible dose of the least toxic agent or argents, Dr. Stamper continued. Dosing should not be increased based on an automatic schedule, but on the patient’s actual condition. If glaucoma is not progressing, there is probably no positive reason to escalate dosing or switch to a more toxic agent.

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