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Beta-blockers’ position in glaucoma arsenal still vital, physician says
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 L. Jay Katz, MD, FACS, spoke about prostaglandin analogs here in Las Vegas. |
LAS VEGAS — Now that prostaglandin analogs are accepted as first-line therapy for glaucoma, beta-blockers are the clear second-line choice, said L. Jay Katz, MD, FACS, here at the Ocular Surgery News Symposium, Glaucoma: Improving Your Odds.
But there are new thoughts on the advantages, limitations and side effects of the “aging king” of glaucoma medical therapy, Dr. Katz said.
For instance, the policy of not prescribing beta-blockers in patients with congestive heart failure has been re-evaluated. “The philosophy has changed in the internal medicine community,” he said.
Earlier restrictions on using beta-blockers in the evening because of fears that ocular circulation may be compromised have also been thrown out, Dr. Katz said, as have concerns about effects such as vasodilation. Physicians should remain cautious about prescribing beta blockers to patients with asthma and bradyarrythmia, Dr. Katz said.
“Patients have benefited from new delivery systems that have been formulated for us, whether you are talking suspensions or gel-forming solutions,” said Dr. Katz. He noted that these new features can make beta-blockers safer and easier to use and allow for a better dosing schedule. Patients may benefit from the once-daily formulation of Istalol (timolol, Ista Pharmaceuticals), which was approved for marketing by U.S. regulators in early June, he said.
Istalol is a timolol maleate solution with added potassium sorbate. U.S. clinical trials found that use of this once-daily 0.5% formulation with the added sorbate provided pressure control equivalent to timolol solution twice a day. Dr. Katz said it is assumed that the reason for this is that the sorbate increases penetration of the timolol.
Beta-blockers may have been relegated to the role of a second-line alternative to prostaglandins, Dr. Katz said, but they can still be used as first-line therapy, usually in combination with another drug.