Update on the role of alpha-agonists in glaucoma management

Stella Arthur, Louis Cantor

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Glaucoma is the second most common cause of world blindness (following cataract) with estimated cases reaching 79.6 million by 2020. Although the etiology of glaucoma is multi-factorial, intraocular pressure (IOP) is the only modifiable factor in glaucoma management proven to alter the natural course of the disease. Among various classes of IOP-lowering medications currently available, alpha-adrenergic receptor agonists are used either as monotherapy, as second-line therapy, or in fixed combination with beta-blockers. Non-selective adrenergic agonists such as epinephrine and dipivefrin are infrequently used today for the treatment of glaucoma or ocular hypertension, and have been replaced by the alpha-2-selective agonists. The use of apraclonidine for IOP reduction in glaucoma or OHT is limited due to a high rate of follicular conjunctivitis. The alpha-2-selective agonist in use today is brimonidine. The brimonidine-purite formulations are preferred to brimonidine-benzalkonium chloride (BAC) formulations due better tolerability while maintaining similar efficacy. Brimonidine is also effective when used in combination with a beta-blocker. Using brimonidine-timolol fixed combination (BTFC) as first-line therapy has an added potential for neuroprotection. This would be a valuable strategy for glaucoma treatment, for patients who are intolerant of prostaglandin analogs, or for patients where prostaglandin analogues are contraindicated as first-line therapy, such as in patients with inflammatory glaucoma.

Original languageEnglish
Pages (from-to)271-283
Number of pages13
JournalExperimental Eye Research
Volume93
Issue number3
DOIs
StatePublished - Sep 2011

Fingerprint

Glaucoma
Intraocular Pressure
Synthetic Prostaglandins
Adrenergic alpha-Agonists
Benzalkonium Compounds
Therapeutics
Timolol
Ocular Hypertension
Adrenergic Agonists
Conjunctivitis
Blindness
Cataract
Epinephrine
Brimonidine Tartrate

Keywords

  • Alpha-agonists
  • Compliance and cost of alpha-agonists
  • Fixed combinations
  • Glaucoma
  • Monotherapy
  • Neuroprotection
  • Ocular blood flow
  • Safety and efficacy

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

Cite this

Update on the role of alpha-agonists in glaucoma management. / Arthur, Stella; Cantor, Louis.

In: Experimental Eye Research, Vol. 93, No. 3, 09.2011, p. 271-283.

Research output: Contribution to journalArticle

@article{f018e68ab3c54808bf3ee2d3abe60884,
title = "Update on the role of alpha-agonists in glaucoma management",
abstract = "Glaucoma is the second most common cause of world blindness (following cataract) with estimated cases reaching 79.6 million by 2020. Although the etiology of glaucoma is multi-factorial, intraocular pressure (IOP) is the only modifiable factor in glaucoma management proven to alter the natural course of the disease. Among various classes of IOP-lowering medications currently available, alpha-adrenergic receptor agonists are used either as monotherapy, as second-line therapy, or in fixed combination with beta-blockers. Non-selective adrenergic agonists such as epinephrine and dipivefrin are infrequently used today for the treatment of glaucoma or ocular hypertension, and have been replaced by the alpha-2-selective agonists. The use of apraclonidine for IOP reduction in glaucoma or OHT is limited due to a high rate of follicular conjunctivitis. The alpha-2-selective agonist in use today is brimonidine. The brimonidine-purite formulations are preferred to brimonidine-benzalkonium chloride (BAC) formulations due better tolerability while maintaining similar efficacy. Brimonidine is also effective when used in combination with a beta-blocker. Using brimonidine-timolol fixed combination (BTFC) as first-line therapy has an added potential for neuroprotection. This would be a valuable strategy for glaucoma treatment, for patients who are intolerant of prostaglandin analogs, or for patients where prostaglandin analogues are contraindicated as first-line therapy, such as in patients with inflammatory glaucoma.",
keywords = "Alpha-agonists, Compliance and cost of alpha-agonists, Fixed combinations, Glaucoma, Monotherapy, Neuroprotection, Ocular blood flow, Safety and efficacy",
author = "Stella Arthur and Louis Cantor",
year = "2011",
month = "9",
doi = "10.1016/j.exer.2011.04.002",
language = "English",
volume = "93",
pages = "271--283",
journal = "Experimental Eye Research",
issn = "0014-4835",
publisher = "Academic Press Inc.",
number = "3",

}

TY - JOUR

T1 - Update on the role of alpha-agonists in glaucoma management

AU - Arthur, Stella

AU - Cantor, Louis

PY - 2011/9

Y1 - 2011/9

N2 - Glaucoma is the second most common cause of world blindness (following cataract) with estimated cases reaching 79.6 million by 2020. Although the etiology of glaucoma is multi-factorial, intraocular pressure (IOP) is the only modifiable factor in glaucoma management proven to alter the natural course of the disease. Among various classes of IOP-lowering medications currently available, alpha-adrenergic receptor agonists are used either as monotherapy, as second-line therapy, or in fixed combination with beta-blockers. Non-selective adrenergic agonists such as epinephrine and dipivefrin are infrequently used today for the treatment of glaucoma or ocular hypertension, and have been replaced by the alpha-2-selective agonists. The use of apraclonidine for IOP reduction in glaucoma or OHT is limited due to a high rate of follicular conjunctivitis. The alpha-2-selective agonist in use today is brimonidine. The brimonidine-purite formulations are preferred to brimonidine-benzalkonium chloride (BAC) formulations due better tolerability while maintaining similar efficacy. Brimonidine is also effective when used in combination with a beta-blocker. Using brimonidine-timolol fixed combination (BTFC) as first-line therapy has an added potential for neuroprotection. This would be a valuable strategy for glaucoma treatment, for patients who are intolerant of prostaglandin analogs, or for patients where prostaglandin analogues are contraindicated as first-line therapy, such as in patients with inflammatory glaucoma.

AB - Glaucoma is the second most common cause of world blindness (following cataract) with estimated cases reaching 79.6 million by 2020. Although the etiology of glaucoma is multi-factorial, intraocular pressure (IOP) is the only modifiable factor in glaucoma management proven to alter the natural course of the disease. Among various classes of IOP-lowering medications currently available, alpha-adrenergic receptor agonists are used either as monotherapy, as second-line therapy, or in fixed combination with beta-blockers. Non-selective adrenergic agonists such as epinephrine and dipivefrin are infrequently used today for the treatment of glaucoma or ocular hypertension, and have been replaced by the alpha-2-selective agonists. The use of apraclonidine for IOP reduction in glaucoma or OHT is limited due to a high rate of follicular conjunctivitis. The alpha-2-selective agonist in use today is brimonidine. The brimonidine-purite formulations are preferred to brimonidine-benzalkonium chloride (BAC) formulations due better tolerability while maintaining similar efficacy. Brimonidine is also effective when used in combination with a beta-blocker. Using brimonidine-timolol fixed combination (BTFC) as first-line therapy has an added potential for neuroprotection. This would be a valuable strategy for glaucoma treatment, for patients who are intolerant of prostaglandin analogs, or for patients where prostaglandin analogues are contraindicated as first-line therapy, such as in patients with inflammatory glaucoma.

KW - Alpha-agonists

KW - Compliance and cost of alpha-agonists

KW - Fixed combinations

KW - Glaucoma

KW - Monotherapy

KW - Neuroprotection

KW - Ocular blood flow

KW - Safety and efficacy

UR - http://www.scopus.com/inward/record.url?scp=80054946438&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80054946438&partnerID=8YFLogxK

U2 - 10.1016/j.exer.2011.04.002

DO - 10.1016/j.exer.2011.04.002

M3 - Article

C2 - 21524649

AN - SCOPUS:80054946438

VL - 93

SP - 271

EP - 283

JO - Experimental Eye Research

JF - Experimental Eye Research

SN - 0014-4835

IS - 3

ER -