Alpha agonists and beta blockers jointly as first-line therapy in primary open-angle glaucoma

Materials and Methods: This is a retrospective study involving 102 patients having primary open angle glaucoma already been treated with beta blockers and alpha agonists as first line of therapy, secondary glaucoma from any cause and one eyed patients from any cause were excluded from study. Period of study-18 months 

Methodology: Beta blockers (Betaxolol only) was given to already diagnosed primary open angle glaucoma cases.Timolol was avoided owing to its occult risk of enhancing pulmonary vascular burden. Alpha agonists was being added after base line monitoring of intraocular pressure.  I.O.P. was checked initially at baseline and at monthly intervals for 3 months followed by every 2 months.I.O.P. was checked with Goldmann applanation tonometer. All cases were of moderate disease and target pressure was set up around 12-15 mm Hg. 76percent cases were seen to achieve IOP around 15-16 mm Hg,dosage of betaxolol being twice daily and that of alpha agonists being 3 times a day.Visual fields (static perimetry-Humphrey)being tested every 4-6 months and OCT (RNFL analysis,GCC) being done every 6 months. Repeat field testing was done in patients with unreliable fields from any cause . Similarly, OCT(RNFL analysis) and GCC were studied again in cases where the signal strength is low.

Discussion: Though prostaglandin analogs have long been regarded as first line of therapy in P.O.A.G which works well apart from few chronic inflammatory disorders and co-existent recent or past viral infections in the eye.comparable results may be obtained with a economically viable above mentioned combination.

Conclusion: An eighteen month retrospective study with selective beta blocker and alpha agonists is not so common as first line of therapy but may be a good option compared to high cost therapy with prostaglandin analogs(particularly  as treatment for glaucoma with medications is life- long)or new stent and tubes for controlling moderate disease in P.O.A.G.In a developing world,where cost is a concern-it may be a economically viable option in general.It may also be mentioned here that results with newer methods for glaucoma (particularly stents)are not yet confirmatory in the long term.