Timing of Eye drops: how precise that should be?

Hi

I was dignoised with glaucoma two month back.

Currently I use Timolet (one Drop in each eye) at around 7.00AM and 7.00 PM. and Lumigen at night around 9.00 PM ( One drop in each eye)

(1) How precisely we should follow this timing of eye drops. Altering time by 30 min or so only for two days in week  (so that it fit to work schedule) should be OK or not?

(2) I am just cureous about : Does one drop of glaucoma medicine is sufficient to contorol IOP for 12 hr or so?

thanks for your advise

Paresh

The simple answer to your first question is that you should be fine altering the time of day for your eye drops two days of the week for your work schedule.

I almost never use my eye drops at exactly the same time of day. My schedule varies by an hour or more very frequently. Precise measurements of my intraocular pressure indicate that this variation does not have any detectable influence. However, other small things related to timing and schedule do have a very large influence on my eye pressure. One of them is the question of how long to wait between drops of two different glaucoma medications. The other thing I have found that has a very profound effect is the activity I perform in the hour following administration of my glaucoma eye drops. (I have not written a detailed explanation of that finding yet, but I will post a link when I do.)

In regard to your second question, I'll share my personal experiences. To my surprise, I found that a single drop of timolol maleate (the regular kind, not the gel-forming solution), which is supposed to control intraocular pressure for only 12 hours, actually controls my eye pressure for a full 24 hours very well. Therefore, I can reduce the side effects of timolol maleate by taking half as much while still receiving the full benefit for glaucoma. (I believe the best way to know for sure if you would get the same result is to work with your eye doctor and check your intraocular pressure frequently over at least one 24-hr period.)

Research has also shown that another glaucoma medication, Xalatan (latanoprost), which is normally used once every 24 hours, actually has a longer period of effectiveness. One study I read indicated that early stage glaucoma patients and ocular hypertensives should be able to receive the full benefit of Xalatan with only a single drop every seven days (1). However, when we tested Xalatan's effects on me, we found that I needed to use it every 24 hours and any longer period between administration resulted in elevated intraocular pressure for me.

Therefore, you see that my research gives two results that are a bit unexpected. If you, as an individual glaucoma patient, are not having your eye pressure monitored frequently, you and your doctor are guessing too much in my opinion. Intraocular pressure in glaucoma should be managed at least as well as blood sugar in diabetes. As you know, a diabetic will often check their blood sugar several times a day under different conditions (post-meal, morning fasting, etc.).

1. Shimon Kurtz and Gabi Shemesh, “The Efficacy and Safety of Once-Daily Versus Once-Weekly Latanoprost Treatment for Increased Intraocular Pressure,” August 25, 2004, http://www.liebertonline.com/doi/abs/10.1089/1080768041725353
   "Latanoprost treatment once-weekly was as effective, and bore fewer minor side effects, as once-daily treatment..."
   

Dave,

      When you put the Timoptic and Xalatan drops in your eyes do you have any trouble with some spilling over?  My daughter's eyes will usually not really hold more than one drop at a time.  I was just wondering if this might reduce the effectiveness of the two drops at once approach.  Just wondering what your thoughts are on this.  We're going to try doing both drops together.

Thanks,

Sabra   

Sabra:

do you have any trouble with some spilling over? 

Yes, some of it often does spill over. More spills over with Travatan-Z than with Xalatan.

My local ophthalmologist told me that the drop size is many times larger than what the eye will hold. He feels like it is a bit of a scam by the drug companies because if the drop size was appropriate, a bottle of glaucoma medication would last many times longer. He told me not to worry if all of the drop doesn't stay in the eye.

His theory seems to hold water because the spill-over has no adverse effect on my intraocular pressure. I certainly have enough intraocular pressure data to detect any difference if there was one.

I'm using Travatan-Z instead of Xalatan (and I'm still using timolol maleate .25%) at the moment and it feels like the entire dose of eye drops spills right out of my eye after I finish punctal occlusion. However, as with Xalatan, it doesn't seem to make a difference in my eye pressure.

Let me know how this works for you. Good luck wth it.