Mr Akash Raj MBBS & MD (AIIMS), MRCS, DRCOphth, FRCS, FRCOphth, PG Dip (Distinction) Consultant Ophthalmologist, Glaucoma specialist and Cataract surgeon, Birmingham, Dudley, Ashby De La Zouch, Midlands, UK
Mr Akash Raj MBBS & MD (AIIMS), MRCS, DRCOphth, FRCS, FRCOphth, PG Dip (Distinction)Consultant Ophthalmologist, Glaucoma specialist and Cataract surgeon, Birmingham, Dudley, Ashby De La Zouch, Midlands, UK 

Medical management: Eye drops

 

 

Medications to treat glaucoma are classified by their active ingredient. These include: prostaglandin analogues, beta blockers, alpha agonists, and carbonic anhydrase inhibitors. In addition, combination drugs/drops are available for patients who require more than one type of medication. Eye drops used in treating glaucomadecreases pressure in the eye by either increasing the drainage of fluid out of the eye or to by decreasing the formation of fluid in the eye in the first place or by both mechanisms.

 

 

Various types of Glaucoma drops are as follows:

 

 

 

Prostaglandin analogues (Decreases pressure in the eye by increasing drainage of fluid from the eye): They are the most commonly used anti-glaucoma preparation currently used. They are quite user frindley as only one drop is needed per eye per day and have the least number of side effects. The common preparations in this group are: Latanoprost(Xalatan), Monoprost (Preservative free Latanoprost), Bimatroprost (Lumigan, including preservative free preparation), Travaprost (Travatan), Tafluprost (Saflutan, preservative free drop).

 

Contraindications: Pregnancy, allergy

 

Common Side Effects: Brown pigmentation of iris, Increased length of eye lashes, red eyes (mostly transient).

 

 

 

Beta blockers (Decrease pressure in the eye by decreasing fluid formation in the eye): They used to be the most commonly used anti-glaucoma drops before prostaglandin analogues came into use. Now a days they are the second most commonly used group of anti-glaucoma drops. This group comprises drops like: Timoptol (Timolol 0.5%, preserved or preservative free and used twice daily), Timoptol LA(Long acting) 0.25% used once daily, Gel Tiopex 0.1%(preservative free and used once daily) and Betaxolol (Betoptic 0.5%, used twice daily). You are advised not to take this as the last thing before bed as this group of drops can reduce blood pressure which may compromise blood flow to the optic nerve leading to faster progression and worsening of glaucoma.

 

Contraindications: Asthma, COPD, shortness of breath, airway and lung diseases, congestive heart failure, heart block and low heart rate (Bradycardia).

 

Side effects: Dry eyes, allergy, fatigue,  shortness of breath, decreased heart rate, decreased blood pressure, depression, loss of libido.

 

Carbonic anhydrase inhibitors Decreases pressure in the eye by decreasing fluid formation in the eye). The medication in this group are: Dorzolamide (Trusopt 2%, preserved or preservative free, used 2-3 times daily), Brinzolamide (Azopt 1%, used 2-3 times daily) and Tablet. Acetazolamide (Diamox 250mg tablet, used 1-4 times daily). The tablet Diamox is usually meant for a short duration due to its side effect profile.

 

Contraindications: Kidney diseses, allergy. Acetazolamide therapy is contraindicated in situations in which sodium and/or potassium blood serum levels are depressed, in cases of marked kidney and liver disease or dysfunction, in suprarenal gland failure, and in hyperchloremic acidosis. It is contraindicated in patients with cirrhosis because of the risk of development of hepatic encephalopathy.

 

Side effects: Allergy, pins and needles (tingling sensation) on finger tips and toes, lethargy, decreased appetite, stinging sensation, depression, increased frequency of urination. Caution is advised for patients receiving concomitant high-dose aspirin and Diamox, as anorexia, tachypnea, lethargy, metabolic acidosis, coma, and death have been reported.

 

WARNING

 

Fatalities have occurred, although rarely, due to severe reactions to sulfonamides including Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, anaphylaxis, agranulocytosis, aplastic anemia, and other blood dyscrasias. Sensitizations may recur when a sulfonamide is readministered irrespective of the route of administration. If signs of hypersensitivity or other serious reactions occur, discontinue use of this drug and get seen to by your GP/A&E.

 

 

 

 

Alpha agonists ( Decreases eye pressure by dual mechanisms of increasing outflow and reduction of fluid formation in the eye). This group comprises Brimonidine (Alphagan/Alphagan P, 0.1-0.15%, used 2-3 times daily), Apraclonidine (Iopidine, 0.5% or 1% used 3 times daily).

 

Contraindications: Allergy

 

Side effects: Burning or stinging, fatigue, headache, drowsiness, dry mouth and nose, relatively higher likelihood of allergic reaction.

 

 

 

GENERAL INSTRUCTIONS ABOUT MEDICATIONS

 

1. Please read information/instruction leaflet carefully

2. Avoid if you are allergic to it

3. Store it as instructed in the information leaflet, avoid direct sunlight

4. Discard after 4 weeks of opening the bottle

5. Wash your hands before application of drops

6. Glaucoma is a blinding disease, please use your drops regularly and as instructed without fail.

7. You must continue with drops unless changed or stopped by your doctor

8. You will get a month's supply from the hospital at the beginning, please go to your GP for all susequent and timely represcription.

9. Please discuss with your doctor/GP any concern you have about interaction of your various medications if you are taking more than one.

10. Please take your medications on a set time and keep a diary if possible.

11. Please carry your prescription & details of your medicines/drops every time you visit any doctor.

 

 

Contact lenses

 

Caution:

 

For those who usually wear contact lenses and have been prescribed eye drops, you may need to stop wearing your contact lenses and wear glasses instead. This is because medication in the eye drops can build up in the contact lenses and may cause toxicity and harm your eyes. One way around this may be to use your eye drops about an hour before putting on your contact lenses and after half an hour after removing your contact lenses. Please discuss your circumstances with Mr Raj or his team.

 

 

 

Information Video:

 

http://www.youtube.com/watch?v=X9NgArAMAQ8

 

 

Medications to treat glaucoma are classified by their active ingredient. These include: prostaglandin analogues, beta blockers, alpha agonists, and carbonic anhydrase inhibitors. In addition, combination drugs/drops are available for patients who require more than one type of medication. Eye drops used in treating glaucoma decreases pressure in the eye by either increasing the drainage of fluid out of the eye or to by decreasing the formation of fluid in the eye in the first place or by both mechanisms.

 

 

Various types of Glaucoma drops are as follows:

 

 

 

Prostaglandin analogues (Decreases pressure in the eye by increasing drainage of fluid from the eye): They are the most commonly used anti-glaucoma preparation currently used. They are quite user frindley as only one drop is needed per eye per day and have the least number of side effects. The common preparations in this group are: Latanoprost(Xalatan), Monoprost (Preservative free Latanoprost), Bimatroprost (Lumigan, including preservative free preparation), Travaprost (Travatan), Tafluprost (Saflutan, preservative free drop).

 

Contraindications: Pregnancy, allergy

 

Common Side Effects: Brown pigmentation of iris, Increased length of eye lashes, red eyes (mostly transient).

 

 

 

Beta blockers (Decrease pressure in the eye by decreasing fluid formation in the eye): They used to be the most commonly used anti-glaucoma drops before prostaglandin analogues came into use. Now a days they are the second most commonly used group of anti-glaucoma drops. This group comprises drops like: Timoptol (Timolol 0.5%, preserved or preservative free and used twice daily), Timoptol LA(Long acting) 0.25% used once daily, Gel Tiopex 0.1%(preservative free and used once daily) and Betaxolol (Betoptic 0.5%, used twice daily). You are advised not to take this as the last thing before bed as this group of drops can reduce blood pressure which may compromise blood flow to the optic nerve leading to faster progression and worsening of glaucoma.

 

Contraindications: Asthma, COPD, shortness of breath, airway and lung diseases, congestive heart failure, heart block and low heart rate (Bradycardia).

 

Side effects: Dry eyes, allergy, fatigue,  shortness of breath, decreased heart rate, decreased blood pressure, depression, loss of libido.

 

Carbonic anhydrase inhibitors ( Decreases pressure in the eye by decreasing fluid formation in the eye). The medication in this group are: Dorzolamide (Trusopt 2%, preserved or preservative free, used 2-3 times daily), Brinzolamide (Azopt 1%, used 2-3 times daily) and Tablet. Acetazolamide (Diamox 250mg tablet, used 1-4 times daily). The tablet Diamox is usually meant for a short duration due to its side effect profile.

 

Contraindications: Kidney diseses, allergy. Acetazolamide therapy is contraindicated in situations in which sodium and/or potassium blood serum levels are depressed, in cases of marked kidney and liver disease or dysfunction, in suprarenal gland failure, and in hyperchloremic acidosis. It is contraindicated in patients with cirrhosis because of the risk of development of hepatic encephalopathy.

 

Side effects: Allergy, pins and needles (tingling sensation) on finger tips and toes, lethargy, decreased appetite, stinging sensation, depression, increased frequency of urination. Caution is advised for patients receiving concomitant high-dose aspirin and Diamox, as anorexia, tachypnea, lethargy, metabolic acidosis, coma, and death have been reported.

 

WARNING

 

Fatalities have occurred, although rarely, due to severe reactions to sulfonamides including Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, anaphylaxis, agranulocytosis, aplastic anemia, and other blood dyscrasias. Sensitizations may recur when a sulfonamide is readministered irrespective of the route of administration. If signs of hypersensitivity or other serious reactions occur, discontinue use of this drug and get seen to by your GP/A&E.

 

 

 

 

Alpha agonists ( Decreases eye pressure by dual mechanisms of increasing outflow and reduction of fluid formation in the eye). This group comprises Brimonidine (Alphagan/Alphagan P, 0.1-0.15%, used 2-3 times daily), Apraclonidine (Iopidine, 0.5% or 1% used 3 times daily).

 

Contraindications: Allergy

 

Side effects: Burning or stinging, fatigue, headache, drowsiness, dry mouth and nose, relatively higher likelihood of allergic reaction.

 

 

 

GENERAL INSTRUCTIONS ABOUT MEDICATIONS

 

1. Please read information/instruction leaflet carefully

2. Avoid if you are allergic to it

3. Store it as instructed in the information leaflet, avoid direct sunlight

4. Discard after 4 weeks of opening the bottle

5. Wash your hands before application of drops

6. Glaucoma is a blinding disease, please use your drops regularly and as instructed without fail.

7. You must continue with drops unless changed or stopped by your doctor

8. You will get a month's supply from the hospital at the beginning, please go to your GP for all susequent and timely represcription.

9. Please discuss with your doctor/GP any concern you have about interaction of your various medications if you are taking more than one.

10. Please take your medications on a set time and keep a diary if possible.

11. Please carry your prescription & details of your medicines/drops every time you visit any doctor.

 

 

Contact lenses

 

Caution:

 

For those who usually wear contact lenses and have been prescribed eye drops, you may need to stop wearing your contact lenses and wear glasses instead. This is because medication in the eye drops can build up in the contact lenses and may cause toxicity and harm your eyes. One way around this may be to use your eye drops about an hour before putting on your contact lenses and after half an hour after removing your contact lenses. Please discuss your circumstances with Mr Raj or his team.

 

 

 

Information Video:

 

http://www.youtube.com/watch?v=X9NgArAMAQ8

 

Private & NHS patients

How to see Mr Raj

For private patients & referrals

 

Mr Akash Raj 

Consultant Ophthalmologist, Glaucoma specialist & Cataract surgeon

 

West Midland Hospital

(Alternate Thursday AM)

Colman Hill

Halesowen

West Midlands

B63 2AH

 

Appointments:

01384 632 640

 

Private Secretary: Liz Carter : 01384 632 636 

                               Fax:     01384 632702

                                            FAO Liz Carter

 

 

 

Mr Akash Raj

Consultant Ophthalmologist, Glaucoma & Cataract specialist

 

BMI The Priory Hospital, Edgbaston

(Thursday PM)
Priory Rd, Birmingham, West Midlands
B5 7UG
 
Appointments:
0121 446 1638
(Consultation by appointment only)
 
Private Secretary:
Liz Carter
Direct Line: 01384632636 

 



 

 

 

 

For NHS Referrals through GP/Opticians

 

Mr Akash Raj

Consultant Ophthalmologist (Glaucoma Lead)

 

Russells Hall Hospital

Pensnett Road

Dudley

West Midlands

DY1 2HQ

 

Phone: 01384456111

Extn. 5815 (NHS Secretary: Lyn Eaton)

 

Fax:     01384244880

            FAO  Lyn Eaton

 



Mr Raj's private consultation times

Telephone consultations @ mutually convenient times. Please see options above.

 



Thursdays (alternate) 9am to 12 Noon @ West Midland Hospital, Colman Hill, Halesowen.

 

 

 

EveryThursday (2 pm - 4 pm) @   The Priory Hospital, Edgbaston(With prior appointments only)

 

 

 

 

Ashby Eye Clinic: 

 

Every Friday at Dr Dawes's Surgery. Please call the surgery for appointments.

The Surgery, Ashby
30 North Street
Ashby-de-la-zouch
Leicestershire, LE65 1HS
Tel: 01530 417415

Please lookout for timings.

http://www.thesurgerynorthstreetashby.nhs.uk

 

 

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