Brimonidine .2% as a replacement for beta blockers in geriatric patients with glaucoma

This 3-month multicenter, open-label study of 89 geriatric patients with glaucoma evaluated the substitution of brimonidine twice daily for topical beta blockers that had been used for at least 6 months. The primary outcome measures were reduction in intraocular pressure (IOP) from baseline at 2 hours postdose, change in cardiac and respiratory function, quality of life, and patient satisfaction. Patients were queried about adverse events at each visit and completed a quality-of-life questionnaire at the final evaluation. In this cohort with a mean age of 75.4 years, the average duration of topical beta-blocker therapy was 5 years. Brimonidine twice daily produced an additional mean reduction in IOP of 8.2% (1.4 mm Hg; P<.001). Eighty-eight percent of patients (60/68) reported being at least as satisfied with brimonidine as with their previous beta-blocker regimen, and 46% (31/68) reported greater satisfaction with brimonidine. Additionally, 40% of patients (27/68) noted increased energy after the switch, and 43% (29/68) described brimonidine as more soothing than topical beta blockers. In this elderly population, the replacement of topical beta blockers with brimonidine twice daily significantly decreased IOP, improved quality of life, and enhanced patient satisfaction.