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Kenneth A. Simon, M.D.
Department of Ophthalmology Washington University School of Medicine 640 S. Kingshighway Blvd. St. Louis

Arch Ophthalmol. 1962;68(5):718.

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To the Editor:

—May I call a few points to your attention in connection with your recent editorial "Cardiac Glycosides and Glaucoma" (ARCH. OPHTHAL. 68:155-156, 1962). First, on mechanism of action: the best evidence to date suggests that these digitalis drugs interfere directly with the enzymatic transport of sodium and potassium, probably by competitive inhibition of potassium binding on the external surface of the cell. They do not alter ATP production. Other drugs which do inhibit ATP synthesis (e.g., DNP) may indirectly affect the transport system, which has a high specificity for ATP as its energy source.

Second, on your suggestion of wide clinical trial for the cardiac glycosides in glaucoma, it is my feeling that their hazardous toxicology demands great caution, but they may find a place in selected cases of medically and surgically refractory glaucomas, particularly the congenital glaucomas. With careful regulation of dosage, I have been able . . . [Full Text PDF of this Article]

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