For what degree of glaucoma is medication considered first-line therapy? Are oral beta blockers as effective as local ones?
—Mario E. Palacios, MD, Egg Harbor Twp., N.J.

Clearly, if there is evidence of glaucomatous damage to the optic nerve or the visual field, the pressure must be lowered to retard progression. Many clinicians will also treat when certain risk factors are present, especially significantly elevated intraocular pressure. These clinicians believe, with some justification, that they can reduce the likelihood of glaucomatous damage.

Some studies have investigated the advisability of laser first or surgery first for the treatment of various degrees of glaucoma, but most practitioners in this country would start with topical medications as the first line of attack.

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Although topical beta blockers are occasionally all too effective systemically (e.g., for complications of heart block and acute asthma, etc.), oral beta blockers are generally ineffective as antiglaucoma medication.
—B. David Gorman, MD, clinical assistant professor of ophthalmology, New York University School of Medicine, New York City (104-14)