Glaucoma and Ocular Hypertension Management with Timolol

Initial Therapy and Dosing

Prostaglandin analogs are the most frequently prescribed initial therapy for glaucoma because they are most efficacious, well-tolerated, and require only once-daily dosing, according to the American Academy of Ophthalmology 1, 2

The target intraocular pressure (IOP) should be approximately 20% lower than baseline mean IOP measurements, as recommended by the American Academy of Ophthalmology 3, 4
Regular assessment of IOP is necessary, and the target pressure should be adjusted based on optic nerve structure and visual field stability, with a strength of evidence supported by the American Academy of Ophthalmology 3

To reduce systemic absorption of timolol, patients should be educated on eyelid closure or nasolacrimal duct occlusion when applying drops, as advised by the American Academy of Ophthalmology 5
When using multiple drop regimens, patients should wait at least 5 minutes between different eye drop medications, according to the American Academy of Ophthalmology 5
Adherence to eye-drop administration can be supported by linking it to daily activities and providing repeated instruction on proper technique, as recommended by the American Academy of Ophthalmology 5, 6

Timolol is FDA Pregnancy Category C, and while beta-blockers tend to be used during pregnancy due to long-term experience, careful risk-benefit assessment is required, as noted by the American Academy of Ophthalmology 5, 6
Nearly 45% of patients take fewer than 75% of prescribed doses even with instruction, highlighting the need for simplified regimens and counseling to improve adherence, according to the American Academy of Ophthalmology 5