Aims-To evaluate the short term cardiovascular, respiratory, and intraocular pressure (IOP) eVects of four glaucoma medications in newly diagnosed glaucoma patients. Methods-141 newly diagnosed glaucoma patients were recruited and underwent a full ocular, cardiovascular, and respiratory examination, including an electrocardiogram (ECG) and spirometry. They were prescribed one of four topical glaucoma medications and reviewed 3 months later. One eye of each patient was randomly chosen for analysis, performed using analysis of variance and the 2 test. Results-Latanoprost had the greatest mean IOP lowering eVect in both the primary open angle glaucoma (POAG) (p = 0.005) and the "presumed" normal tension glaucoma (NTG) groups (p = 0.33), reducing the IOP by 8.9 mm Hg and 4.1 mm Hg respectively. Timolol was associated with lowered pulse rates and reductions in the spirometry measurements. 41% of patients using brimonidine complained of systemic side eVects and over 55% of patients using betaxolol complained of ocular irritation. 28% of patients required an alteration in their glaucoma management.Conclusions-Latanoprost appears to be a useful primary treatment for glaucoma patients, in view of superior IOP control and a low incidence of local and systemic side eVects. Timolol causes a reduction in measurements of respiratory function, a concern in view of the potential subclinical reversible airways disease in the elderly glaucoma population. Brimonidine is associated with substantial, unpredictable systemic side eVects and betaxolol causes ocular irritation and weak IOP control. Spirometry is advised in all patients receiving topical blocker therapy to control their glaucoma. (Br J Ophthalmol 2000;84:710-713) Glaucoma is a common disease within the elderly population, aVecting over 5% of those older than 75 years.

Objectives-Subjective visual deficits are common after demyelinating optic neuritis despite the frequent return of normal visual acuity. Visual and electrodiagnostic tests have demonstrated evidence of these persisting functional abnormalities, which are thought to be secondary to demyelination and variable axonal loss in the optic nerve. Scanning laser polarimetry (SLP) is a new image analysis technique which uses the polarising properties of the retinal nerve fibre layer (RNFL) to produce a quantitative measure of its thickness. This study was carried out to assess the prevalence, extent, and pattern of RNFL loss after demyelinating optic neuritis using SLP. Methods-Twenty four patients with a history of previous demyelinating optic neuritis were re-examined. Examination included measurement of logmar visual acuity, Pelli-Robson contrast sensitivity, and the presence of a relative aVerent pupil defect and optic atrophy. SLP was performed and a mean RNFL profile from a series of three images from each eye was constructed. This was compared with normative data from 20 age matched normal subjects. The lower 99.9% confidence limit of the normal data was calculated and used as the cut oV criterion for abnormality. Results-There were a total of 31 eyes with a history of demyelinating optic neuritis and SLP disclosed an abnormality in 29 (94%) of these. Twenty three eyes recovered an acuity of 0.0 or better, 21 of which had evidence of RNFL loss on polarimetry. Scanning laser polarimetry was the only abnormality found in nine of the 31 eyes (29%). The pattern and extent of RNFL loss was very variable and there was no significant diVerence in these indices between patients with multiple sclerosis compared with those with isolated demyelinating optic neuritis. Conclusion-Scanning laser polarimetry can provide a quantitative measure of RNFL loss after demyelinating optic neuritis, demonstrating its occurrence in a high percentage of patients recovering normal visual acuity. (J Neurol Neurosurg Psychiatry 1998;64:505-509)

(Br J Ophthalmol 1998;82:684-690)