Treatment of intraocular pressure in Elderly patients

The aim of this paper is to study the effect of many systemic antihypertension drugs on intraocular pressure and on the visual field. Six hundred patients were enrolled in this experiment with the approval of the Ethical Committee of our hospital. All patients were divided into four groups: the first group of 200 patients was treated with local or systemic administration of a calcium channel blocker; the second group of 200 patients was treated with oral or systemic administration of β-blockers; the third group of 100 patients was treated with systemic administration of ACE inhibitors; and the fourth group of 100 patients was treated with a diuretic drug (acetazolamide). All patients were subjected monthly to measurements of their systemic blood pressure, intraocular pressure, and visual field. Our results confirm that the oral administration of a calcium channel blocker (nitrendipina) in subjects with moderate essential hypertension and without ocular hypertonia causes systemic effects with a moderate decrease of ocular pressure, while the ocular instillation of the same drug causes a remarkable general hypotensive effect. The scotoma in glaucomatous subjects with normal pressure gets better after the administration of local calcium channel blockers, showing that the peripheral vascular reaction enhances the optical nerve blood flow. The oral administration of β-blockers is also correlated with a reduction of the intraocular pressure, especially if the β-blocker also reduces the systemic blood pressure. Nadolol, a long half-life, nonselective β-blocker, in a single oral dose of 20 or 40 mg, may result in a remarkable decrease of the intraocular pressure during the whole day. It has been demonstrated that the systemic administration of ACE inhibitors is also effective in reducing intraocular pressure by some mechanisms which, although not known yet, seem to act on the posterior ciliary arteries, shunting the blood to the ciliary body. Finally, acetazolamide, a diuretic usually used to reduce systemic blood pressure, is also able to reduce intraocular pressure. On the other hand, if perfusion pressure is reduced as a consequence of antihypertensive treatment, damage to the visual field could be accelerated.