Since the introduction of timolol in 1978, OBBs have been a popular choice for monotherapy for elevated IOP. They are now viewed as an alternative to prosta-

glandin analogues for initial monotherapy, an adjunctive therapy, or as a component of fixed-combination therapy. As such, they remain a useful class of medication. After only a few years, it was widely appreciated that OBBs had the potential to cause the same constellation of adverse effects as did systemic beta blockers. The population with glaucoma tends to be older and may be more susceptible to subtle effects, or may have other medical conditions that could interact with drugs in this class. However, at least one review of the available literature has suggested that the evidence for adverse effects from OBBs has not been rigorously analyzed or accurately represented.95 The routine use of timolol 0.5% twice daily should be reconsidered by clinicians. This once-popular regimen may be excessive for at least some patients, both in concentration and in frequency. It is essential to obtain a thorough medical history before prescribing OBBs for a patient. It is also appropriate to measure and record heart rate and blood pressure. Communication with the primary medical care provider is essential to help avoid possible drug-drug and drug-disease interactions. Once-daily dosing, starting treatment with lower concentrations, teaching nasolacrimal occlusion techniques, and prescribing gel-forming solutions may help decrease systemic exposure to the drugs.

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