EP #19: Vision's Vanguard: Understanding the Potency of Glaucoma Medications

Have you ever wondered how a few tiny drops can be a game-changer in the fight against glaucoma? This episode promises to demystify the treatments that are crucial for managing this sneak thief of sight. Your host Dr. Thuy Nguyen, along with Jeremy Wolf, delve into the pharmacological frontlines of glaucoma therapy, emphasizing the role of eye drops in reducing intraocular pressure.

We journey through the complexities of prostaglandin analogs—the go-to warriors for many practitioners—while addressing the potential inflammation concerns for certain patients. The discussion also branches out into beta blockers like timolol, unpacking their effectiveness and safety considerations for individuals with respiratory issues. It's not just clinical jargon; Jeremy chimes in with personal stories about his father-in-law's struggles with glaucoma, highlighting the profound impact of early detection and diligent treatment. This episode is an essential guide for anyone touched by glaucoma, looking for clarity and hope in their vision care journey.

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Transcript

Speaker 1: 0:03

Welcome to the Jazzy Eyes podcast. Taking care of your vision with expert precision. Here's your host, dr Tui Nguyen.

Jeremy: 0:14

Hello everyone, welcome back to the Jazzy Eyes podcast. Jeremy Wolf here joined by your host, dr Tui Nguyen. We have been on a glaucoma tear. It is Glaucoma Awareness Month and we were talking all about glaucoma. Dr Falco was talking about primary glaucoma. You got into a little bit about secondary glaucoma on the previous segment. So what's on the agenda for this segment, dr Nguyen?

Dr. Nguyen: 0:38

So I wanted to talk about like pharmacological drops or medications that we prescribe to manage glaucoma. In this one there are. So glaucoma is a build of a pressure in the eyes, so these drop target to lower the pressure in the eyes. Either it opens up the drainage pathway of the eyes or it reduces or decreases production of fluid in the eyes, all of which can decrease pressure in the eyes. When we prescribe these drops to you, the goal is to reduce the pressure by 25 to 30%, and then we see you back in about two weeks after prescribing these drops to see if you know, the pressure is reduced by that much. There are three major classes of drops that I wanted to talk about, one being the first line drop that most practitioners prescribe in myocococoma, and they're called prostaglandin analogs, short in.

Jeremy: 1:35

PGA Everything has such a complicated name in this.

Dr. Nguyen: 1:40

I like the abbreviations better the acronyms.

Dr. Nguyen: 1:42

That's what everyone abbreviates anything that's more than two syllables. So prostaglandin analogs, or PGA. They're prescribed and generally used once a night, every night. They're the most efficient because they usually, on average, lower the pressure about 30%. They are they work by promoting or opening up drainage pathways in the eyes, and so they open up the pores or make the pores bigger by relaxing muscles, and when the muscles relax, the pores just naturally open up to allow fluid to pass through. The only issue with the PGA is that they're pro-inflammatory by nature, and so we don't give it to those who are already experiencing inflammatory eye conditions, such as inflammatory glaucoma that we talked about in the previous podcast. There's also another class of glaucoma drops. They're called beta blockers and they a most common beta blocker is called timolo.

Jeremy: 2:43

Beta blocker drops Beta blocker drops. I've had them in pill form before.

Dr. Nguyen: 2:47

Yes, yes they are all beta blocks.

Dr. Nguyen: 2:50

Yeah, and so funny that you mentioned that. So timolo is an eye drop that's used. They usually use about twice a day. Not as efficient as PGA's but still pretty good 25% reduction in the pressure. They're usually people caution to prescribe them and those with asthma or COPD, because they can cause decrease in respiration. Now, the systemic absorption of eye drops is very low and so people aren't too. It's not too too high of a risk that you're going to have respiratory decrease when prescribing these eye drops. But if you are taking orals, that's something that more people are more cautioned about. So they do come in orals, but we're not as concerned with systemic absorption when it comes to drops, but we do want to keep in mind that we might want to give it to someone with asthma or COPD.

Jeremy: 3:45

Man, you guys really are a wealth of knowledge when it comes to this stuff. Yes, so much good information. I got to get these episodes over to my father-in-law. Yeah, father-in-law, he has glaucoma, oh yeah. And he's blind as a bat.

Dr. Nguyen: 4:04

Yeah, yeah. So when we catch early we're able to slow down or prevent any vision loss. Too late for him now, I think.

Jeremy: 4:12

He's approaching 80 and he's been wearing like super thick contact lenses for a while because nothing works about those. But I'm sure he'll get a kick out of listening to all this stuff.

Dr. Nguyen: 4:23

anyway, oh yeah, Very informational. It's a whole month just dedicated for glaucoma. And so there's one last category of medication for glaucoma and it's called carbonic anhydrase inhibitor. Otherwise, you know what? I'm saying there's another one there's two more.

Jeremy: 4:43

Excuse me. Oh, my goodness, I'm coming off a pretty nasty illness.

Dr. Nguyen: 4:49

I can't stop coughing, I know Okay.

Jeremy: 4:52

Please proceed, sorry, yes, so see, don't mind me. Don't mind me.

Dr. Nguyen: 4:56

As you're dying over there. Caas are another class of drops that are used to manage glaucoma. It's not used as often because it's not as efficient. It lowers the pressure by 18, 20%. They're usually used in combination with another class, but they contain sulfa, and so we caution to prescribe this medication in those who have sulfa allergies. Caaas are also available in oral form, but they're not used as often because of the serious side effects. They leave a metallic taste in the mouth and so that's very unpleasant, and they can also cause tingly in the hands and feet, which is why we don't use them in oral form as often, unless there is a very high pressure spike that needs to be lowered right away in office. Then we throw whatever we can at it to get the pressure to go down.

Jeremy: 5:50

I really want to get into a whole another segment maybe not with you guys, but just somebody in general about the whole metallic taste in the mouth due to medications, because I've had that before from some other medications. It's such a strange thing and I'm curious to learn about why and how that happens. Obviously not right now, but maybe that's a topic for a future discussion.

Dr. Nguyen: 6:13

I know it's such an unpleasant side effect.

Jeremy: 6:15

Yeah, it's just so interesting that you get a metallic taste in your mouth from very much.

Dr. Nguyen: 6:19

Yeah, like, how does that happen, right? I mean that's it.

Jeremy: 6:24

All right, well, let's wrap it up there, unless there is something else you want to share, but I know we got a lot of information out there today, so I think we're good there.

Dr. Nguyen: 6:34

The most major glaucoma drops that most practitioners will put you on to help manage glaucoma. They can be used as standalone treatments or in combinations with each other, but those are the most used in managing glaucoma.

Jeremy: 6:46

All right, sounds good, dr Newell. Until next time. Have a wonderful day, have a wonderful week and I will see you soon. Thank you To our listeners. Thanks as always for tuning in and we will catch you next time. Everyone take care, cool.

Speaker 1: 7:03

Thank you for listening to the Jazzy Eyes podcast. For more information, visit jazzyeyescom or contact 954-473-0100.