Medical therapy for glaucoma: what to add after a prostaglandin analogs?
AI Summary
After PGAs, adding alpha2 agonists, beta blockers, or CAIs similarly lowers diurnal IOP, but side effects and nocturnal/trough efficacy vary. Laser trabeculoplasty is also effective.
Abstract
Purpose of review: Prostaglandin analogs (PGAs) are the most widely used ocular hypotensive medications. Half of the patients with glaucoma and 40% of patients with ocular hypertension require more than one medication to sufficiently lower their intraocular pressures (IOPs). Therefore, it is important to understand the varying efficacy of adjunctive therapies currently available for use in combination with PGAs.
Recent findings: The IOP-lowering efficacy and safety profiles of various adjunctive treatments continue to be better elucidated, including the nocturnal IOP-lowering efficacy of various medication classes and laser trabeculoplasty.
Summary
For patients already on a PGA, the mean diurnal IOP-lowering achieved with the addition of an alpha2 adrenergic agonist, a beta adrenergic antagonist, or a topical carbonic anhydrase inhibitor is similar, whereas the side-effect profiles, nocturnal IOP-lowering efficacy, and trough IOP-lowering effects vary. Laser trabeculoplasty is also an effective means of further lowering the IOP in patients on a PGA.
MeSH Terms
Shields Classification
Key Concepts4
The mean diurnal IOP-lowering achieved with the addition of an alpha2 adrenergic agonist, a beta adrenergic antagonist, or a topical carbonic anhydrase inhibitor is similar for patients already on a prostaglandin analog (PGA).
The side-effect profiles, nocturnal IOP-lowering efficacy, and trough IOP-lowering effects vary among alpha2 adrenergic agonists, beta adrenergic antagonists, and topical carbonic anhydrase inhibitors when added to a prostaglandin analog (PGA).
Laser trabeculoplasty is an effective means of further lowering the intraocular pressure (IOP) in patients already on a prostaglandin analog (PGA).
Half of the patients with glaucoma and 40% of patients with ocular hypertension require more than one medication to sufficiently lower their intraocular pressures (IOPs).
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