Glaucoma medications, glaucoma therapy, and the evolving paradigm.

BACKGROUND: Therapy for the glaucomas is dynamic, with changes evolving as new medications or modalities are discovered. In comparing the method(s) of treating open-angle glaucoma today, as compared to treatment in the 1980s, clear differences emerge. While topical beta-blockers remain the mainstay for treatment of open-angle glaucoma, other medications and modalities have recently become available that supplement their use. Topical carbonic anhydrase inhibitors (CAIs), introduced in 1995, have become an important addition to the glaucoma armamentarium. They are more useful than their oral counterparts, since they cause fewer systemic side effects, with similar efficacy. Brimonidine, a topical alpha2-adrenergic agonist, and latanoprost, a topical prostaglandin, have become important additions to the glaucoma regimen because of their ability to reduce the intraocular pressure (i.o.p.) with an improved therapeutic index, as compared to older medications. Finally, argon laser trabeculoplasty (ALT) appears to be a safe technique and useful in reduction of IOP.
CONCLUSION: The scheme for how the anti-glaucoma medications and modalities are used for the therapy of open-angle glaucoma will change over time. The evolution will occur as we continue to learn more about the drugs presently being used.