Glaucoma: medications and paying cash

Overview

Glaucoma is a group of conditions that damage the optic nerve, usually in association with raised pressure inside the eye. The common form, open-angle glaucoma, causes no symptoms early and slowly narrows side vision, which is why regular eye examinations matter, especially for people over sixty, those with a family history, diabetes or high blood pressure, and people of African descent. Lost vision cannot be restored, but lowering eye pressure slows or stops further damage.

Prostaglandin drops, latanoprost, bimatoprost and travoprost, taken once each evening, are usually the first drops prescribed. Timolol, a beta blocker drop, is avoided in asthma and some heart conditions because enough is absorbed to affect breathing and pulse. Brimonidine and dorzolamide are other classes, and several are sold in combination bottles. Selective laser trabeculoplasty is an alternative or addition to drops, and surgery is used when other treatments are not enough.

Acute angle-closure glaucoma, with sudden eye pain, redness, blurred vision and nausea, is a different condition and an emergency.

Choosing between the options when you pay cash

Latanoprost, timolol, brimonidine and dorzolamide are available as generics, and quotes for the same bottle can differ between pharmacies. Brand-name combination drops and preservative-free products are separate products from the generics they combine; ask the prescriber whether two generic bottles would suit you instead.

Insurance plans may limit how early an eye-drop refill can be filled, which causes problems when a bottle runs out early; a cash purchase is not subject to that plan limit, and a prescription that allows several bottles per fill helps avoid running short.

Medicines at a glance

How the medicines in this group are supplied and usually taken. Each guide has the full details.

• Latanoprost
  Eye drops in a multi-dose bottle (Xalatan and generic), Preservative-free single-dose containers (Iyuzeh)
  Generic: Yes · Once a day
• Timolol
  Eye drops 0.25 and 0.5 percent (Timoptic and generics), Preservative-free single-use drops (Timoptic in Ocudose), Gel-forming solution (Timoptic-XE and generics)
  Generic: Yes · Twice a day
• Dorzolamide-Timolol
  Eye drops in a multi-dose bottle (preserved), Preservative-free single-use vials
  Generic: Yes · Twice a day
• Brinzolamide
  Eye drops (suspension) in a multi-dose bottle
  Generic: Yes · Three times a day
• Acetazolamide
  Tablets, Extended-release capsules, Injection (hospital use)
  Generic: Yes · Once a day

Medications

Which of these is right for a given person is a decision for the prescriber. The guides explain what each drug is, how it is supplied, and why its cash price varies between pharmacies. No page on this site shows a price; prices come from pharmacies responding to your actual prescription.

Questions worth asking

• What eye pressure are we aiming for, and when is my next check?
• Is a generic drop, or two generic bottles, suitable instead of a brand combination?
• Should I consider laser treatment instead of or alongside drops?
• How do I put drops in so that less is wasted?
• Do any of my drops affect my breathing or heart medicines?

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