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Generally, the first course of action a doctor will take when eye pressures are too high because of ocular hypertension, or if one has been diagnosed with open angle glaucoma, is to do a trial with glaucoma eye drops. There are many varieties of glaucoma drops with different eye pressure lowering effects. A doctor will prescribe one or more of these based on the patient's individual situation. Factors such as type of glaucoma and/or other health issues determine which drugs will be prescribed. Therefore, a doctor will often do a trial to determine the pressure lowering effect, reported side effects, and/or any other health issues. For example beta blockers may not be suitable for those with low blood pressure etc.
In the Glaucoma Medications article, there are several classifications of these drugs, but they all work to either lessen the production of aqueous fluid or more commonly, they work to increase aqueous outflow through the drainage system in the front part (or trabecula) of the eye. Drainage enhancement is the function of the newer prostaglandin based drugs. Besides reduced systemic side effects with the newer prostaglandin eye drops, there is the added advantage of better control of IOP at night and in early morning hours. Additionally, they increase patient compliance because they only need to be taken once per day. However, even some of the older medications which are not commonly used, still have value in certain situations. For example, glaucoma specialist Dr. Robert Ritch finds pilocarpine to be of use in the management of pseudo exfoliation glaucoma and managing diurnal pressure spikes in some of his patients.
Because many patients require more than one type of drop to lower pressures sufficiently, there are drops which combine two different drugs in the same product. This can be convenient if a patient does not wish to go through the rigor and inconvenience of taking different drops separately. This may also decrease harmful side effects. For example, combinations may lessen the amount of preservative exposure to the eye.
Since all IOP lowering medications have side effects, it is important to pay close attention and provide feedback to the doctor. One medication may be substituted for another with fewer side effects. Also, if one practices self tonometry, gathering useful data such as the time of day when drops are the most effective, whether certain drops can be taken on alternate days (usually prostaglandins), whether the current medications need supplementation because they are not lowering pressures sufficiently, and whether short acting medications could be added in anticipation of circumstances known to raise eye pressures. For example, Bailey of FitEyes supplements with alphagan (in addition to the prostaglandin) when circumstances warrant. 'Sally' has been able to reduce her medications and take them every other day or so.