Glaucoma is a neurodegenerative eye condition often associated with increased intraocular pressure (IOP) ^[1]. If untreated, it can lead to gradual visual field loss and, ultimately, complete blindness. Globally, glaucoma is the second leading cause of blindness ^[2]. It is defined by progressive neuropathy of the optic nerve, characterized by structural changes to the optic nerve head or optic disk, which result in functional visual field impairments. By 2020, nearly 80 million people were projected to have glaucoma, with this number expected to rise to 111.8 million by 2040 ^[4], disproportionately affecting populations in Asia and Africa. In South Africa, the prevalence of glaucoma is estimated at 5-7% in Black populations and 3-5% in White populations ^[4].

Types of Glaucoma

1. Open-Angle Glaucoma: This form occurs due to optic nerve damage, which may happen at any IOP level. Progression can be slow or rapid, with increased IOP potentially preceding noticeable changes to the optic disk or visual field ^{[7 – 9]}.
2. Closed-Angle Glaucoma: This type involves physical blockage of the trabecular meshwork, leading to more acute onset than open-angle glaucoma. IOP exceeding 40 mmHg can cause optic nerve damage, while levels above 60 mmHg may result in permanent damage ^{[7 – 9]}.
3. Medicine-Induced Glaucoma: Certain medications can elevate IOP, aggravate pre-existing glaucoma, or induce the condition ^[9].

Risk Factors of glaucoma ^{[10, 11]}: Several risk factors contribute to glaucoma development, including:

• Elevated IOP: A primary risk factor, particularly for angle-closure glaucoma in individuals over 40.
• Age: Risk increases significantly after age 60.
• Family History: A genetic predisposition, especially in juvenile open-angle glaucoma cases.
• Co-morbidities: Conditions such as diabetes, hypertension, and hyperthyroidism.
• Pre-existing Ocular Conditions: Eye tumors, retinal detachment, lens dislocation, or previous ocular surgery.
• Corticosteroid Therapy: Prolonged use of corticosteroids, including topical forms, can trigger glaucoma.

Management and Treatment Options

Non-Pharmacological Measures - Surgical interventions, such as iridectomy, offer definitive treatment for closed-angle glaucoma ^[7].

Pharmacological Treatments - The primary goal is to lower IOP to prevent retinal ganglion cell death. Treatment should aim to reach the patient’s target IOP with the simplest regimen possible. Available IOP-lowering agents include:

• α-Adrenergic Agonists: E.g., apraclonidine, brimonidine.
• β-Blockers: E.g., Betaxolol, levobunolol, timolol.
• Carbonic Anhydrase Inhibitors: E.g., acetazolamide, dorzolamide.
• Cholinergic Agonists: E.g., carbachol, pilocarpine.
• Prostaglandin Analogues: E.g., latanoprost, travoprost ^[8].

For patients with ocular hypertension (IOP > 22 mmHg), a suitable first-line agent should be initiated to prevent progression of disease. The main aim of the study the effectiveness of ocular drug in the treatment of glaucoma.

The study was conducted in the Outpatient Department of Ophthalmology at a tertiary care hospital over a one year, from February to April, following approval from the institutional ethics committee. Written informed consent was obtained from patients or their attendants. patients under inclusion criteria, they were divided into four groups and named as group A, B, C & D. Group a patients were treated with latanoprost, group b patients were treated with bimatoprost, group c were treated with pilocarpine and group d were treated with timolol respectively. The sociodemographical status like comorbidity, education, married status, present symptoms, duration of illness, blood pressure, IOP was noted.

Inclusion Criteria

1. Patients aged 30–80 years attending the ophthalmology OPD.
2. Patients able to adhere to the follow-up schedule.
3. Patients or their attendants willing to provide informed consent.
4. Patients with financial support to purchase required medications.
5. Patients not using any ocular drugs at the time of enrolment.

Exclusion Criteria

1. Patients younger than 80 years of age.
2. Patients wearing contact lenses during the study period.
3. Patients with any ocular disorders.
4. Patients with a history of ocular surgery within the last one months.
5. Patients or their attendants unwilling to provide informed consent.

Study Design

Participants were randomly divided into three groups using the chit method:

• Group A: Patients treated with latanoprost
• Group B: Patients treated with bimatoprost
• Group C: Patients treated with Pilocarpine
• Group D: Patients treated with Timolol

Statistical Analysis

Data collected during the study were recorded in Microsoft Excel and analysed using SPSS software (version 16). An unpaired t-test was conducted to compare the Four groups. A p-value of less than 0.05 was considered statistically significant, while a p-value of less than 0.005 was deemed highly significant.

Table 1 & 2 shows the age and gender distribution of the study population. Of the 184 patients, 55 (29.89%) are between 41 – 50 years old, while 49 (26.63%) are between 51 - 60 years old. Among the participants, 136 (73.91%) are male, and 48 (26.08%) are female.

Table 3 Shows the educational status of glaucoma patients, were majority of the patients had SSC 88 (47.82%) followed by graduate 39 (21.19%), secondary education 27 (14.67%), postgraduate 19 (10.32%) and none 11 (05.97%) respectively.

Table 4 Marital status of glaucoma patients showing that majority of the patients were married 139 (75.54%) followed by 32 (17.39%) single, 08 (04.34%) widowed and 05 (02.71%) divorced respectively.

Table 5 showing present symptoms were as 167 (90.76%) patients had poor vision. Among 167 patients 124 (74.25%) unable to read followed by 37 (22.15%) unable to walk and 06 (3.59%) were hitting the objective during walking respectively. In time treatment of glaucoma is essential for patients otherwise it may lead to complete blindness. As per the study 104 (54.52%) patients had glaucoma <6 months followed by 80 (43.47%) patients had glaucoma > 6 months. As per the present study comorbidity observed in glaucoma patients were diabetes followed by hypertension, myopia, eye injury, migraine followed by drug use respectively.

In the patients with glaucoma there will be a raised in Table 05 ocular changes observed in glaucoma patients after treatment with ocular eye drops. Intraocular pressure was observed at 8am of all the four groups after treatment at 8 am it was measured as after treatment at 8pm showing insignificant (p > 0.050) between all the four groups

Table 01 Gender group difference in study groups.

Table 02 Age group difference among study populations.

Table 03: sociodemographic status in glaucoma patients.

Table 04 Ocular and correlated diseases observed in glaucoma patients.

Table 05 ocular changes observed in glaucoma patients after treatment with ocular eye drops.

Glaucoma is a disease of eye showing increased in intraocular pressure causes effecting in single or both eyes. There are different classes of drug that causes decrease in intraocular pressure in eyes by acting of different areas of eyes. This study was carried out on glaucoma patients attending OPD of ophthalmology department at tertiary care hospital. As per the study the majority of the patients were male 136 (73.91) followed by female 48 (26.08%) under the age group of 41 – 50 years 55 (29.89%) followed by 51 – 60 years 49 (26.63%), 61 – 70 35 35 (19.02%), 30 -40 years 27 (14.56%) and 71 – 80 years 18 (09.78%) respectively (Table No 02). Education status in glaucoma patients showing 88 (47.82%) had primary education followed by 39 (21.19%) had graduate, 27 (14.67%) had secondary education, 19 (10.32%) had postgraduate education and 11 (05.97%) had no education (Table No 03).  Married status, 139 (75.54%) had married followed by 32 are single, 8 (4.34%) are widowed and 05 (2.71%) had divorced respectively. The patients had symptoms after attending OPD, 167 (90.74%) and 17 (9.23%) had none symptoms of eye. Among 167 (9.16%) majority of the patients are unable to read 124 (74.25%), 37 (22.15%) followed by 6 (3.59%) had hitting to objectives respectively. The duration of illness of glaucoma, 104 (54.52%) had less than 6 months in duration of developing illness. Diabetes is a major cofactor observed in glaucoma patients followed by myopia and hypertension respectively. Glaucoma is caused due to increase in intraocular pressure as per the present study in in group A, B, C, & D at 8 am the IOP was 28.1±1.34, 28.16±1.82 27.12±1.64          26.14±1.54 (p0.226) at 11 am 26.4±1.21 24.14±1.6424.21±1.42      25.01±1.34 (p0.216), 2 pm 24.4±1.20 22.18±1.42, 24.10±1.22, 24.11±1.22 (p 0.168), 5 pm 22.4±1.17, 18.18±1.26 22.14±1.26, 22.80±1.12 0.136 and at 8 pm 20.1±0.18, 16.14±0.86, 20.16±1.04, 20.16±0.15    0.114 respectively and Cup-disc ration 0.74±0.08, 0.72±0.04, 0.76±0.06, 0.072±0.06 (p 0.146) respectively. After comparting all four groups there is a insignificant mean reduction in intraocular pressure observed after treatment with ocular drugs (p<0.05).

Polagani, Padma, et al. (2016) ^[12] noted that while topical bimatoprost preparations are more expensive than topical timolol maleate, their effectiveness in reducing intraocular pressure—a key modifiable factor in preventing optic nerve head damage—supports their role in preserving visual function, thereby enhancing vision quality and overall quality of life.

Franks, Wendy A., et al. (2006) ^[13] reported no significant difference in mean intraocular pressure (IOP) changes from baseline between travoprost 0.004% and the latanoprost 0.005%/timolol 0.5% fixed combination at follow-up. Both treatments were well tolerated by patients.

Bimatoprost demonstrates a greater reduction in intraocular pressure compared to pilocarpine, travoprost, and timolol in the treatment of ocular glaucoma.

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