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Lowering IOP With Medical Therapy in Patients With Glaucoma: Conclusion



Although there are always well-designed studies of glaucoma medications as monotherapy performed as part of the approval or registration process, there are few well-designed prospective studies of additivity of adjunctive therapy to a prostaglandin. With no consistency of clinical trial design, patient characteristics, or methods of analysis in existing studies, head-to-head comparisons are difficult, at best. What is known is that all 3 currently widely available prostaglandins are effective in IOP lowering and remain first-line choices because of their efficacy, safety, and convenience as once-daily agents. Also, the beta-blockers, topical CAIs, and alpha-agonists are all additive to different prostaglandins with varying efficacies. It is also important to note that although medicines may be additive in clinical trials, adding multiple medicines may have limited efficacy in the real-world setting. In fact, adding another medication to a regimen of 2 or 3 medications frequently does not achieve a significant fall in IOP. This phenomenon may be most easily explained by the fact that patients are less likely to use their medications as prescribed when dosing regimens become complex.[46] In such instances, fixed-combination therapies are another important option. With so many available choices, the real challenge for clinicians is to keep therapy reasonable when faced with resistant glaucoma.

This activity is supported by an independent educational grant from Allergan.

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