Skip to main content
SpringerLink
Log in

Medical Treatment: First Line Agents and Monotherapy

  • Chapter
  • First Online:
Pearls of Glaucoma Management

  • 1339 Accesses

Abstract

Timolol maleate was the most potent topical IOP-lowering drug introduced after pilocarpine and epinephrine years ago, and a number of different beta-blocker preparations were approved after its introduction into the marketplace. Following its approval by the U.S. Food and Drug Administration (FDA) in 1978, it was considered the gold standard initial treatment for nearly two decades until 1996 when the first prostaglandin analog was granted approval by the FDA. Prostaglandin analogs are more potent IOP-lowering drugs than timolol and other beta blockers. However, this fact does not mean that beta blockers cannot be used as a first-line agent. This class of medication remains efficacious, tolerated, and cost effective. The following history is an illustration of this reality.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Airaksinen PJ, Valkonen R, Stenborg T, et al. (1987) A double-masked study of timolol and pilocarpine combined. Am J Ophthalmol 104:587–590.

    PubMed  CAS  Google Scholar 

  2. Allingham RR, Damji K, Freedman S, et al (2005) Adrenergic receptor antagonists. In: Shield’s Textbook of Glaucoma. Lippincott Williams and Wilkins, Philadelphia.

    Google Scholar 

  3. Allingham RR, Damji K, Freedman S, et al (2005) Prosta­glandins and hypotensive lipids. In: Shield’s Textbook of Glaucoma. Lippincott Williams and Wilkins, Philadelphia.

    Google Scholar 

  4. Boger WP III (1983) Short term “escape” and long term “drift”: the dissipation effects of the beta adrenergic agents. Surv Ophthalmol 28suppl:235–242.

    Article  PubMed  Google Scholar 

  5. Camras CB, Hedman K, US Latanoprost Study Group (2003) Rate of response to latanoprost or timolol with ocular hypertension or glaucoma. J Glaucoma 12:466–469.

    Google Scholar 

  6. Caprioli J, Sears M, Bausher L, et al. (1984) Forskolin lowers intraocular pressure by reducing aqueous inflow. Invest Ophthalmol Vis Sci 25:268–277.

    PubMed  CAS  Google Scholar 

  7. Choudhri S, Wand M, Shields MB (2000) A comparison of dorzolamide-timolol combination versus the concomitant drugs. Am J Ophthalmol 130:832–833.

    Article  PubMed  CAS  Google Scholar 

  8. Coleman AL, Diehl DLC, Jampel HD, et al. (1990) Topical timolol decreases plasma high-density lipoprotein cholesterol level. Arch Ophtalmol 108:1260–1263.

    Article  CAS  Google Scholar 

  9. Cvenkel B, Stewart JA, Nelson LA, et al. (2008) Dorzolamide/timolol fixed combination versus latanoprost/timolol fixed combination in patients with primary open-angle glaucoma or ocular hypertension. Curr Eye Res 33:163–168.

    Article  PubMed  CAS  Google Scholar 

  10. Dunham CN, Spaide RF, Dunham G (1994) The contralateral reduction of intraocular pressure by timolol. Br J Ophthalmol 78:38–40.

    Article  PubMed  CAS  Google Scholar 

  11. Fechtner RD (1999) Beta blockers. In: Netland PA, Allen RC (eds), Glaucoma Medical Therapy Principles and Management. The Foundation of the American Academy of Ophthalmology, San Francisco.

    Google Scholar 

  12. Feghali JG, Kaufman PL (1985) Decreased intraocular pressure in the hypertensive human eye with betaxolol, a β1 – adrenergic antagonist. Am J Ophthalmol 100:777–782.

    PubMed  CAS  Google Scholar 

  13. Feldman RM, Tanna AP, Gross RL, et al. (2007) Comparison of the ocular hypotensive efficacy of adjunctive brimonidine 0.15% or brinzolamide 1% in combination with travoprost 0.004%. Ophthalmology 114:1248–1254.

    Article  PubMed  Google Scholar 

  14. Gieser SC, Juzych M, Robin AL, et al (1996) Clinical pharmacology of adrenergic drugs. In: Ritch R, Shields MB, Krupin T (eds), The Glaucomas. Mosby, St. Louis

    Google Scholar 

  15. Goethals M (1989) Ten year follow-up of timolol-treated open angle glaucoma. Surv Ophthalmol 33 Suppl:463–464.

    Article  PubMed  Google Scholar 

  16. Hejkal TW, Toris CB, Camras CB (1999) Prostaglandin analogs. In: Netland PA, Allen RC (eds), Glaucoma Medical Therapy Principles and Management. The Foundation of the American Academy of Ophthalmology, San Francisco.

    Google Scholar 

  17. Hommer A, Ganfort Investigators Group I (2007) A double-masked, randomized, parallel comparison of a fixed combination of bimatoprost 0.03%/timolol 0.5% with non-fixed combination use in patients with glaucoma or ocular hipertensión. Eur J Ophthalmol 17:53–62.

    PubMed  CAS  Google Scholar 

  18. Kass MA, Heuer DK, Higginbotham EJ, et al (2002)The Ocular Hypertension Treatment Study Group. The Ocular Hyper­tension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 120:701–713.

    Article  PubMed  Google Scholar 

  19. Konstas AG, Nakos E, Tersis I, et al. (2002) A comparison of once daily morning vs evening dosing of concomitant latanoprost/timolol. Am J Ophthalmol 133:753–757.

    Article  PubMed  CAS  Google Scholar 

  20. Konstas AG, Katsimpris IE, Kaltsos K, et al. (2008) Twenty-four-hour efficacy of the brimonidine/timolol fixed combination versus therapy with the unfixed components. Eye 22:1391–1397.

    Article  PubMed  CAS  Google Scholar 

  21. Konstas AG, Kozobolis VP, Tsironi S, et al. (2008) Comparison of the 24 hour intraocular pressure-lowering effects of latanoprost and dorzolamide/timolol fixed combination after 2 and 6 months of treatment. Ophthalmology 115:99–103.

    Article  PubMed  Google Scholar 

  22. Lama PJ (2002) Systemic adverse effects of beta-adrenergic blockers: an evidence based assessment. Am J Ophthalmol 134:749.

    Article  PubMed  CAS  Google Scholar 

  23. McCannel CA, Heinrich SR, Brubacker RF (1992) Acetazol­amide but not timolol lowers aqueous humor flow in sleeping humans. Graefes Arch Clin Exp Ophthalmol 230:513–520.

    Article  Google Scholar 

  24. Mittag TW (1996) Adrenergic and Dopaminergic Drugs in Glaucoma. In: Ritch R, Shields MB, Krupin T (eds), The Glaucomas. Mosby, St. Louis.

    Google Scholar 

  25. O’Connor DJ, Martone JF, Mead A (2002) Additive intraocular pressure lowering effect of various medications with latanoprost. Am J Ophthalmol 133:836–837.

    Article  PubMed  Google Scholar 

  26. Rylander NR, Vold SV (2008) Cost analysis of glaucoma medications. Am J Ophthalmol 145:106–113.

    Article  PubMed  Google Scholar 

  27. Van Buskirk EM, Fraunfelder FT (1984) Ocular beta-blockers and systemic effects. Am J Ophthamol 98:623–624.

    Google Scholar 

  28. Zimmerman TJ, Kaufman HE (1977) Timolol dose response and duration of action. Arch Ophthalmol 95:605–607.

    Article  PubMed  CAS  Google Scholar 

  29. Zimmerman TJ, Shrir M, Nardin GF, et al. (1992) Therapeutic index of pilocarpine, carbachol and timolol with nasolacrimal Occlusion. Am J Ophthalmol 114:1–7.

    PubMed  CAS  Google Scholar 

  30. Zimmerman TJ (1993) Topical ophthalmic beta blockers: a comparative review. J Ocular Pharm 9:373–384.

    Article  CAS  Google Scholar 

  31. Zimmerman TJ, Stewart WC and the Latanoprost Axis Study Group (2003) Intraocular pressure, safety, and quality of life in glaucoma patients switching to latanoprost from monotherapy treatments. J Ocular Pharmacol Ther 16:557–564.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, School of Medicine, Pontificia Universidad Catolica, Ave. Apoquindo 3990 Suite 708, Santiago, Chile

    Eugenio Maul

Authors
  1. Eugenio Maul
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eugenio Maul .

Editor information

Editors and Affiliations

  1. Jules Stein Eye Institute, Stein Plaza 100, Los Angeles, 90095, U.S.A.

    JoAnn A. Giaconi

  2. Jules Stein Eye Institute, Stein Plaza 100, Los Angeles, 90095, U.S.A.

    Simon K. Law

  3. Jules Stein Eye Institute, Stein Plaza 100, Los Angeles, 90095, U.S.A.

    Anne L. Coleman

  4. Jules Stein Eye Institute, Stein Plaza 100, Los Angeles, 90095, U.S.A.

    Joseph Caprioli

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Maul, E. (2010). Medical Treatment: First Line Agents and Monotherapy. In: Giaconi, J., Law, S., Coleman, A., Caprioli, J. (eds) Pearls of Glaucoma Management. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-68240-0_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-68240-0_24

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-68238-7

  • Online ISBN: 978-3-540-68240-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation