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    Effects of concurrent use of topical, oral beta blockers

    The question surrounding the efficacy and potential adverse effects of beta blocker use

    Recently, I received a progress note from a glaucoma surgeon concerning a patient whom he and I share. The patient is a 58-year-old African-American female with a longstanding history of primary open-angle glaucoma. She has mild cataracts and is under the care of a primary-care physician for hypertension and hypercholesterolemia.

    The patient’s systemic medications are atenolol (Tenormin, AstraZeneca) and simvastatin (Zocor, Merck). The atenolol was a recent change from hydrochlorothiazide (Microzide, Actavis plc) for reasons not readily apparent, and it can be assumed that the hydrochlorothiazide was not yielding a proper efficacy. She is a former crack cocaine user and has been sober for almost 10 years. She has no other known systemic illnesses or medication allergies.

    Related: Standards of care in treating glaucoma

    Her intraocular pressures (IOP) were well controlled for years by a prostaglandin at bedtime and a beta blocker-containing combination drop in the morning and afternoon. Recently, progression was detected, and the decision to have a consultation for selective laser trabeculoplasty (SLT) was made after a discussion with the patient regarding a laser procedure vs. the possible addition of a third drop.

    She did great and has consistently remained at or below target (12 to 14 mm Hg) since then. The most recent consultation note stated that we should change her combination drop because it contained a beta blocker and she is now taking a systemic beta blocker. Using the topical beta blocker would be a contraindication.

    Benjamin P. Casella, OD, FAAO
    Dr. Casella, a 2007 graduate of University of Alabama at Birmingham School of Optometry, practices in Augusta, GA, with his father in ...


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