Zioptan

[melinda68]

Good afternoon Dr Hagen

Will I escape corneal damage/disease if I use Zioptan rather than latanoprost? Will there also be less irritation? (My insurance will pay 80% of the cost, so it is affordable for me). Are there are disadvantages to using it? Thank you :)

[John C Hagan III, MD, FACS, FAAO]

The overwhelming problem with the medicine Zioptan is the cost.   It is preservative free equivalent of latanoprost.   Almost no one is allergic to latanoprost. moreover since the dose is one drop per eye per day very few people have any problem with allergy.   So I use very little zioptan in my practice due to cost problems.

[melinda68]

Cost aside, is it a superior drug? I keep reading about BAK causing inflammation and cell damage

[John C Hagan III, MD, FACS, FAAO]

No it is not superior and I rarely use it.  BAK has been around for decades and is effective and safe.  Usually only a problem when used 4 or more times/day.

[melinda68]

Thanks so much. I need to pay less attention to people in facebook groups and more to doctors. What about the warning  on the drug label about "deepening of the eyelid sulcus"?  Is that something to expect over time? Shrinkage of fat cells? Also is macula edema something that occurs only in those predisposed? Sorry for all the questions. This is my first long-term drug. U have't even had to take an antibiotic in more than 25 years

[John C Hagan III, MD, FACS, FAAO]

When someone has  glaucoma and is not under treatment and the glaucoma is rather mild I offer them two choices:  Selective Laser Trabeculoplasty (SLT).   If the IOP averages about 25 or less then there is about a 70% chance the laser will lower intraocular pressure (IOP)  to a level where drops are not necessary. The person still needs checked every 6 months with special glaucoma tests ideally by an Eye MD ophthalmologist. If the IOP is much higher or the person does not want laser (some people are afraid of it) then I start them on generic latanoprost.  It is safe, effective, inexpensive. It makes the eyelashes longer which women (and some men) love.  Side effects are very rare.  Darkening around the eyelids, and atrophy of the fat within the socket are extremely rare (they are however very common with Lumigan a stronger, longer lasting medicine in the same family and it is brand name and expensive).  Iris color change is only a consideration in iris that are hazel a mix of blue and brown. Over severl years the brown pigment can predominate and the eye can look more brown than hazel.  For brown or blue eyes not a problem.  Don't drive yourself nuts. Every medicine including over the counter have side effects. Thousands of people bleed to death every year from aspirin.  Think about automobile accidents. Are you afraid to get in a car? Over 50,000 people will this year and will be killed.  Life is risky.  Somethings like smoking are extremely risky.  Using latanoprost once per day is not risky and nothing like letting glaucoma make a person go blind.  Move on.

[melinda68]

Thank you so much, Dr Hagen. This really put things in perspective for me. My highest recorded IOP was 24/22, the lowest 19/20 prior to starting drops. However, it is my very low blood pressure that concerns my GS the most. I am still only a glaucoma suspect, and hopefully the latanoprost will keep it that way. My GS is not one to freely offer information and doesn't like answering questions either, so you've been an immense help. Thank you

[John C Hagan III, MD, FACS, FAAO]

Happy to help.