Sometimes when I find a “high” IOP reading I would like to use a drop of a fast acting medication (or go outside and work).
Which of the classes / drops is the fastest acting?
I’m prone to very high IOP spikes and use multiple drops regularly or have in the past (Dorzolamide Timolol, Brimonidine, Travatan Z, Rhopressa, Pilocarpine) and consistently by many docs over the years I have always been recommended to take extra doses of Dorzolamide Timolol and Brimonidine in these occasions when I need a rapid drop. I believe Travatan and Rhopressa are mostly used only once a day and not as fast acting and Pilocarpine may provide a rapid initial drop but many people experience significant side effects from this drop including dimmed and blurry vision and headaches so it may not be the best fit for all. Perhaps also checking with your doctor is best as several drops can have rare but serious side effects outside of IOP control. For example Timolol is known to lower BP in many patients even after punctal occlusion and Pilocarpine has been linked to retinal tears and detachments.
Brimonidine is so fast-acting that some ophthalmologists will use it (as one part of their protocol) in the treatment of emergency acute angle closure glaucoma.
[Brimonidine (Alphagan P)] is fast acting, its duration of of action is about 12hrs and its IOP reduction achieved is about 20-30%, by multiple mechanisms of action. Combination timolol and brimonidine is also an option.
Brimonidine is an Alpha agonist.
I have seen the combination Azopt plus Timolol used in this situation too. Azopt is a carbonic anhydrous inhibitor.
I don't have personal experience with any of those. But Timolol works very fast for me.
Prostaglandin-class drops will probably be slow-acting for everyone (or I should say, most people - probably somebody will come along who is an exception).
Interestingly, weight lifting works even faster than any of the glaucoma medications I have tested. The absolute fastest IOP reduction is achieved with one set of squats (even with light or moderate weight). Of course, the acute effect from exercise only lasts an hour or so. It's not a replacement for glaucoma medications. I am just saying that if you want a near instant and large magnitude decrease in IOP, this method is worth considering too.
But note that if you do the weightlifting incorrectly, it can raise your IOP! I would only recommend this approach to people who have a tonometer and can verify that they are getting the expected decrease in IOP from the activity.
I have a bottle of Betimolol. I recommend you get something fast acting that your doctor and you have tested its effectiveness. Not all medications work for all patients! Some drops backfire and raise IOP or cause very severe side effects.
My doctor and I found with tonomtery in the office immediately after a drop of Betimol was instilled (because I wouldn’t just take the sample bottle and leave like my previous bad experience) that Betimol does indeed drop my pressures during a daytime. It took just a few minutes and the drop’s action began.
I keep my bottle in the refrigerator in a small glass jar. It seems to keep spike away for a day or two, but I also get a grip, pray for peace, and realize I cannot fix this; I am just going through this for now. Tonometer keeps me aware of stress that I hadn’t realized I was holding onto so tightly. Walks are imperative to shift mental outlook and increase blood flow. Something about a walk drops IOP and lifts stresses, often helping me to drop IOP in ten minutes without any eye drop.
A reply from the email discussion:
I am in the UK and would say that Pilocarpine is the standard for a fast acting drop to lower eye pressure. I have tried most of the drops available ie Timolol, Latanaprost, Alphagan and Simbrinza and find that Pilocarpine works best for me.
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We had many comments in the email discussion regarding duration of action of brimonidine, which deserves a separate answer. But in short, the duration of action can be as short as 3 hours for some individuals and as long as 24 hr for others.
Most people did agree that brimonidine is a fast-acting medication for them, but one person said that it is not effective for him.
That's why Mary Beth's advice is important: whatever drop you choose, it would be best if you verify that it produces the desired fast results through self-tonometry or through tonometry in your doctor's office.