A patient on long-term topical timolol 0.5% for glaucoma develops bradycardia and worsening of obstructive airways disease. Which topical IOP-lowering agent would be the SAFEST substitute with a similar or better IOP-lowering efficacy?

• A Levobunolol 0.5% (non-selective beta-blocker)
• B Carteolol 1% (non-selective beta-blocker with ISA)
• C Metipranolol 0.1%
• D Betaxolol 0.5% (beta1-selective blocker) ✓

Explanation

Betaxolol is a cardioselective (beta1-selective) topical beta-blocker, making it relatively safer in patients with obstructive airways disease and cardiac conduction issues compared to non-selective agents. Its IOP-lowering efficacy is slightly less than timolol but it has a neuroprotective profile. Levobunolol and metipranolol are non-selective and carry similar systemic risks as timolol. Carteolol has ISA but is still non-selective.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.