Transcript Glaucoma Algorithm

Algorithm for the Management of Glaucoma
First Choice Monotherapy
1. Prostaglandin (Latanoprost (available as preservative free)
or Travoprost; Tafluprost should be used only if preservative free
product required, and latanoprost PF not tolerated.
2. Beta-Blockers (Timolol, Betaxalol)
yes
(in order of preference)
3. Carbonic Anhydrase Inhibitors (CAI) (Dorzolamide
– preserved and preservative free)
4. Alpha-Agonists (Brimonidine)
Has target Intraocular Pressure (IOP) been achieved?
Is treatment well tolerated?
Change to an alternative first
choice drug for monotherapy.
Continue with Treatment
yes
Target IOP maintained?
yes
no
no
Target IOP achieved?
Add in second drug
Regular follow-up, every 3-4
months to check the following:
no
Is treatment well tolerated?
no
Ineffective due to non-compliance
1. Quality of Life compliance,
and drug side effects
2. IOP
3 .Visual Fields (MD/PSD )
4. Optic disc values (colour
photos)
5. OCT to discs for RNFL and
mGCC
Substitute second drug or consider fixed combination products:; Ganfort
= bimatoprost / timolol, Xalacom = latanoprost / timolol , Azarga =
brinzolamide / timolol; Cosopt = dorzolamide / timolol (also available as
preservative free preparation),
Simbrinza (brinzolamide/brimonidine combination) may be used in
addition to a beta blocker where 4 or more IOP lowering drugs are
necessary. Verify efficacy and tolerability with all combination products
Adapted from European Glaucoma Society Terminology and Guidelines for Glaucoma 3rd Edition 2008.
Mr M J Hassan, Consultant Ophthalmologist. Gillian Turrell, Lead Pharmacist. May 2015
Consider
selective laser
trabeculoplasty ,
penetrating and
non-penetrating
Glaucoma
surgery, or for
tube implant.