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December 1997

Maximal Medical Therapy for Glaucoma

Author Affiliations

Louisville, Ky

Arch Ophthalmol. 1997;115(12):1579-1580. doi:10.1001/archopht.1997.01100160749014

Not too LONG AGO, maximal tolerated medical therapy (MTMT) for glaucoma usually meant a β-blocker, a cholinergic agent (usually pilocarpine or carbachol), and an oral carbonic anhydrase inhibitor (CAI) (usually diamox or neptazane). Sometimes epinephrine or dipivefrin was added to the regimen. Prescribing MTMT for an individual patient depended on whether or not that patient could tolerate any or all of this regimen. With MTMT compliance was always suspect, not just because of the side effects of these drugs, especially the cholinergic agents and the CAIs, but also because of the difficult dosing schedules. At worst, a patient would be taking 4 pills and 6 to 8 drops in each eye daily. The morning and evening dosing could take 15 minutes under the best conditions (the patient applying bilateral nasolacrimal occlusion while a family member administered drops to both eyes every 5 minutes). This would be difficult to tolerate even

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