β-Blocker–Induced Complications and the Patient With Glaucoma

Abstract

Primary open-angle glaucoma is a condition associated with an elevated intraocular pressure (IOP) that is defined as optic degeneration with a slowly progressive deterioration of the visual field that may lead to blindness. More than 1 million Americans are being treated for glaucoma, and 80,000 are legally blind as a result of the disease. Glaucoma has its highest prevalence among the elderly population, with an incidence of approximately 1% in those older than 60 years, 3% in those between the ages of 70 and 80 years, and more than 9% in those older than 80 years. Treatment is directed at lowering high ocular pressures. The initial treatment, in most cases topical therapy with a beta-adrenergic blocking agent, reduces the IOP to help preserve sight. But such topical agents may also have adverse systemic effects on cardiac, pulmonary, central nervous system (CNS), and endocrine functions.

Fixed-combination brinzolamide 1%/brimonidine 0.2% vs monotherapy with brinzolamide or brimonidine in patients with open-angle glaucoma or ocular hypertension: results of a pooled analysis of two phase 3 studies

“…Beta blockers are associated with serious side effects, such as severe respiratory and cardiac reactions. 12, 13 Therefore, all current fixed-combination therapies are contraindicated for patients with certain respiratory or cardiac conditions, including patients with asthma, severe chronic obstructive pulmonary disease, sinus bradycardia, second- or third-degree atrioventricular block, cardiogenic shock, or overt cardiac failure. 4 A study of nearly 26 000 veterans with glaucoma revealed that 23% also had reactive airways disease (an umbrella term encompassing bronchitis, emphysema, asthma, and COPD diagnoses) and 12% had congestive heart failure.…”

“…Furthermore, in that study, 88% of patients with reactive airways disease were dispensed glaucoma medications (primarily beta blockers) that had the potential to aggravate bronchoconstriction. In addition to serious respiratory and cardiac concerns, beta blockers are also associated with altered mental status, 13 which may be insidious and difficult to identify. All of this information taken together demonstrates the unmet need for patients to have a fixed-combination glaucoma medication that does not contain a beta blocker.…”

Beta-Blockers after Myocardial Infarction: Do Benefits Ever Outweigh Risks in Asthma?

“…Avoidance of β-blockers in asthma includes ophthalmic timolol, which has had several deaths associated with its use [15, 16]. Other ophthalmic β-blockers may be tolerated in some patients, but can also cause bronchospasm [31]. …”

“…Metoprolol has been studied in varying doses in patients with asthma in at least 16 trials [17, 18, 26, 27, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40]. In virtually all of these studies, metoprolol caused some decrease in pulmonary function.…”

Effects of Latanoprost and Betaxolol on Cardiovascular and Respiratory Status of Newly Diagnosed Glaucoma Patients

“…These medications may drain down the nasolacrimal duct to be absorbed by the nasopharyngeal mucosa into the systemic circulation [2,3,4,5]. By means of blood circulation, some topically applied medications have the potential of reaching high concentrations causing bradycardia and respiratory impairment [5,6,7]. This may have important clinical implications since there may be undetected reversible airway obstruction in the aging population [2, 8, 9].…”