the Impact of Timolol on Optic Nerve Health and Eye Pressure - Ophthalmology

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Optic nerve head hypoplasia


I have been using Timolol Chauvin 0.50% eye drops (twice daily) for over a year due to elevated intraocular pressure.
My current intraocular pressure is 21 mmHg (it was 26 mmHg before starting the medication).
After starting the drops, I noticed my pulse has become somewhat slower (56-60/min), and I am unsure if this affects blood flow to the eyes.
I would like to ask the following questions:
1) My second ophthalmologist diagnosed me with elevated intraocular pressure but noted that my optic nerve head appears smaller than average (the OCT report shows Disk Area: 1.895 mm², compared to 2.993 mm² before starting the drops).
I am unsure if this is related to the side effects of Timolol Chauvin 0.50%.
The first ophthalmologist (who prescribed the drops) said it is not a side effect of the medication, while my family doctor mentioned that Timolol Chauvin 0.50% can cause the optic nerve head to shrink.
Which doctor's opinion is correct?
2) Does an increase in cup size indicate optic nerve damage? If the optic nerve head continues to shrink, does that also imply optic nerve damage? If the cup size remains unchanged but the disk size decreases, does that mean the rim is also reduced, and could a smaller optic nerve head indicate optic nerve damage?
3) During my visit to the ophthalmologist, my eyes were scanned into a computer.
Does this have any harmful effects on the eyes? If I seek a second opinion from another ophthalmologist and undergo repeated scanning, what potential harm could this cause to my eyes?
4) Many doctors have stated that I only have elevated intraocular pressure.
However, since I have been prescribed Timolol Chauvin 0.50% by the first doctor, could improper management of my eye pressure by this doctor increase my risk of developing actual glaucoma?
5) I have noticed that many glaucoma patients also experience other conditions such as retinal and macular diseases.
Is there a possibility that the side effects of glaucoma medications could lead to these other conditions? What is the likelihood of these occurring?
6) If someone with only elevated intraocular pressure continues to use Timolol Chauvin 0.50% eye drops long-term, what might their visual acuity be like in 20 years?
I have many questions, but I sincerely hope the doctor can address these six inquiries.
Thank you very much.

Xin Fan Ren, 40~49 year old female. Ask Date: 2010/05/17

Dr. Wang Zhishun reply Ophthalmology


Hello: The diagnosis of glaucoma and the decision to initiate treatment are not always clear-cut and often require a comprehensive consideration of various factors.
In your case, it seems not so absolute, and my response may serve as a reference for you.
The examination instruments used in ophthalmology are generally safe, and even with multiple measurements in a professional ophthalmology setting, there should not be any harm.
As for parameters such as disc area and disc cupping, these examinations are supplementary, and it is not advisable to draw conclusions from a single data point; the clinician's judgment remains the most important.
To my knowledge, timolol itself does not reduce visual acuity, has no toxicity to the retina and macula, and does not increase the likelihood of developing glaucoma.
Thank you!

Reply Date: 2010/05/17

More Info


Timolol, a non-selective beta-blocker, is commonly used in the treatment of elevated intraocular pressure (IOP) associated with glaucoma and ocular hypertension. Your concerns regarding its effects on optic nerve health and overall eye pressure are valid, especially given your experience with high eye pressure and the changes in your optic nerve head.

1. Impact of Timolol on Optic Nerve Head Size: The assertion that Timolol can cause optic nerve head atrophy is not widely supported in clinical literature. While some patients may experience changes in optic nerve head morphology, these changes are often attributed to the underlying condition (e.g., glaucoma or ocular hypertension) rather than the medication itself. The decrease in disk area you noted could be a natural progression of your condition or a reflection of the treatment's effectiveness in lowering IOP. It is essential to have regular follow-ups with your ophthalmologist to monitor these changes.

2. Optic Nerve Health and Cup-to-Disk Ratio: The cup-to-disk ratio is a critical indicator of optic nerve health. An increase in the cup size typically suggests optic nerve damage, often associated with glaucoma. If your optic nerve head is shrinking but the cup size remains stable, it may not necessarily indicate nerve death. However, a reduction in the disk size could imply that the rim is also diminishing, which may be concerning. Continuous monitoring through visual field tests and OCT (Optical Coherence Tomography) is crucial to assess any potential nerve damage.

3. Ocular Imaging Safety: The imaging techniques used in ophthalmology, such as OCT, are non-invasive and generally safe. They do not cause harm to the eyes and are essential for diagnosing and monitoring eye conditions. Repeated scans are often necessary to track changes over time, and there is no cumulative risk associated with these procedures.

4. Risk of Glaucoma Development: If your eye pressure is not adequately controlled, there is a risk of developing glaucoma. Timolol is effective in lowering IOP, but if it is not sufficient, or if the underlying condition progresses, the risk of glaucoma increases. It is vital to have open communication with your ophthalmologist about your treatment plan and any concerns you may have regarding your eye pressure management.

5. Potential Side Effects and Other Conditions: While Timolol is generally well-tolerated, some patients may experience systemic side effects, including respiratory issues or cardiovascular effects, particularly if they have pre-existing conditions. However, the development of other retinal conditions is not directly linked to Timolol use. It is essential to differentiate between the effects of the medication and the natural progression of ocular diseases.

6. Long-term Visual Acuity Outcomes: Predicting visual acuity outcomes over 20 years for someone with ocular hypertension on Timolol is challenging. It largely depends on the effectiveness of the treatment in controlling IOP and preventing optic nerve damage. Regular monitoring and timely adjustments to your treatment plan are crucial to maintaining visual acuity.

In summary, while Timolol is an effective treatment for managing elevated IOP, it is essential to have ongoing evaluations to monitor your optic nerve health and adjust treatment as necessary. If you have concerns about your treatment or the effects of the medication, consider seeking a second opinion from another ophthalmologist. Regular follow-ups and open communication with your healthcare provider are key to managing your eye health effectively.

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