Glaucoma is a leading cause of vision loss and irreversible blindness worldwide. Ongoing research yields a continuous flow of new information regarding treatments and possible methods of prevention. 

In the midst of this flow, a variety of outright myths, partial truths, and suppositions continue to circulate among laypeople and professionals alike. In a recent Optometry Times article, experts Dr. Andrew Meagher and Dr. Andrew Gurwood set the record straight on five common beliefs about glaucoma management.*

About glaucoma

Glaucoma occurs when retinal ganglion cells in your optic nerve become damaged. Unless identified and treated quickly, the condition progresses over time, causing vision loss and eventual blindness. Risk factors for developing glaucoma include:

• Family history of glaucoma
• Increased age
• Female sex
• Low central corneal thickness
• Concurrent conditions such as:
  • Migraine headaches
  • Sleep apnea
  • High blood pressure
  • Diabetes
• Increased intraocular pressure (IOP)

IOP is currently the only modifiable risk factor approved for treatment. Just a 20-30% reduction in IOP can lower the risk of and delay (or even halt) disease progression. This is usually achieved through the use of topical and oral medications or surgical procedures.

Glaucoma management myths

Despite ongoing efforts to increase education and raise awareness about glaucoma and its treatments, there are some misconceptions and myths that persist. Here are the facts.

Myth #1. A topical beta-blocker is a good choice for treating normal tension glaucoma (NTG).

Beta-blockers decrease your heart rate, constrict your breathing passageways, and lower your ocular blood pressure and flow (perfusion). Low ocular perfusion is a risk factor of NTG. Because of this, many providers are hesitant to prescribe them as a first-line therapy for patients with NTG. Topical beta-blockers are also not recommended for glaucoma patients with asthma, chronic obstructive pulmonary disease, or other lung conditions. Current recommendations for initial NTG treatment involve either topical prostaglandin analogues (PGAs) or selective laser trabeculoplasty (SLT).

Myth #1 is busted.

Myth #2. Brimonidine drops provide nerve protection against glaucoma damage.

Brimonidine tartrate is a combination of a beta-blocker and an alpha agonist that reduces IOP by helping the eye drain at a faster rate and reducing the production of eye fluid, called aqueous humor. 

Several animal studies have demonstrated that brimonidine has a regenerative effect on optic nerve tissue, and another study indicated that the drug was capable of reducing ganglion-cell death at a much greater rate than timolol, which some consider to be the gold standard in beta-blockers for glaucoma. Whether or not these results can be duplicated and sustained in living people remains to be seen. 

Myth #2 is plausible.

Myths #3 & #4. PGA preparations increase risk of macular edema (swelling) after cataract surgery and in cases of uveitis, a type of eye inflammation.

Topical prostaglandin analogues (PGAs) are highly effective at lowering IOP, and multiple clinical trials have shown that they rarely produce macular edema or reactivate prior inflammation. One study indicated that, in cases where macular edema developed after cataract surgery, the most common contributor was the premature stopping of topical steroid use.

Myths #3 and #4 are busted.

Myth #5. PGA preparations take too long to work to be considered for acute IOP reduction.

PGAs are effective, easy to use, and safe for the open-angle, normal-tension, and angle-closure types of glaucoma. In a direct comparison study, PGAs were found to be at least as effective as timolol as a monotherapy solution for chronic angle-closure glaucoma. 

Myth #5 is busted.

It’s always a good idea to question and substantiate statements and beliefs that may affect your health, even if they are made by medical professionals. You are a critical member of your health team and need to be able to make informed decisions.

*Meagher, A. and Gurwood, A. S. (2021, Apr. 8). 5 Glaucoma Management Myths. Optometry Times. https://www.optometrytimes.com/view/5-glaucoma-management-myths

Any sources from outside of Prevent Blindness do not imply an endorsement from Prevent Blindness. The contents of the material used are the responsibility of the authoring organization, Responsum Health.

The treatment discussed in this article is experimental and has not been approved by the FDA or any regulatory authorities for any use outside of clinical trials. Its safety and efficacy have not been evaluated by the U.S. federal government. If you are considering participating in a clinical trial, learn more about the risks and potential benefits of clinical studies and talk to your healthcare provider before joining.