40 years of topical beta-blockers for glaucoma

Abstract

The introduction of topical beta-blockers in 1978 was a major breakthrough in the treatment of ocular hypertension and glaucoma, and although no longer first-line, betablockers remain a commonly prescribed and important intraocular pressure (IOP) lowering medication. On the 40 th anniversary of their introduction we critique the current role of topical beta-blockers, with particular regard to their efficacy, side effects, and role in fixed-dose combinations. While beta-blockers are effective at lowering IOP during the day, sleep laboratory studies have shown that they have minimal effect overnight, likely due to the physiological nocturnal reduction in aqueous production. Cardiac and respiratory side effects are especially important to consider in elderly patients with multiple comorbidities or in those using multiple systemic medications, which may affect beta-blocker metabolism. The increasing number of alternative medical and minimally invasive surgical options for glaucoma treatment is likely to see a reduction in beta-blocker prescribing.