Usage of Timolol is suitable for night time?

[lswk]

Hi all,

There are some advices that Timolol is not effective at night time for reducing IOP. And as it has a side effect to lower blood pressure, it seems using this before sleeping may bring some risk to optic nerve (as low blood pressure with high IOP at night can lead to low perfusion pressure, which means insufficient blood flow to the optic nerve).

Some references here:

1. skirsch.com/medical/KirschV...

(Long reading but there is a section about different categories of eyedrops, indicating beta blocker like Timolol, or Alpha-2 agonists, are not effective for reducing IOP at night. Better alternatives are Prostaglandin analogs and Carbonic anhydrase inhibitors)

2. researchgate.net/post/Does_...

I had Duotrav prescribed during 2013 - 2018, applied once a day at night. It contains Prostaglandin analogs and Timolol

From 2018 I was prescribed with Simbrinza and Ganfort. Simbrinza (Carbonic anhydrase inhibitors + Alpha-2 agonists) applied twice daily at day time. Ganfort (Prostaglandin analogs and Timolol) applied once daily at night time.

My IOPs are in the range of 15-25 when measured in eye clinic (I keep the records from 2016 onwards). The doctors feel the IOP can be controlled, but the OCT is showing reduction of RNFL thickness year on year (yearly average reduction 4-6%).

And my blood pressure does not read high (have used a smart watch to measure during sleeping, diastolic have 80% of reading in the range 60-70mmHg)

Therefore, I am thinking whether the usage of Timolol at night is appropriate for me. Will check with my doctor on next visit but would like to see if there are any related experiences in this group.

And I also wonder if we can arrange any medical checking to measure 24 hours IOP and blood pressure fluctuation, so there can be a better picture to match the body with the suitable eyedrops. Probably not NHS but not sure if there is any private medical providers offering this.

Thanks in advance for your advice.

[HMThai]

Here is a link which may help

healthunlocked.com/api/redi...

[lswk in reply to HMThai]

Hi HMThai, thanks for your reply. Yes I watched this in your earlier sharing, which trigger me to think about my usage of Timolol with this post.

[praying4cure]

I, too, have been using timolol in the evening (dorzolamide/timolol combination), but have been told that low blood perfusion at night is thought to contribute to my low-tension glaucoma. So, as of tomorrow, I will switch to a stand-alone dorzolamide drop in the evening, and will post here if there seems to be any measurable improvement.