Product information and disease description Place of product in therapy Approaches to treatment Current treatment options and standard of care

Other topical intraocular pressure-lowering medication classes

5 evidence topics · 3 sources

AAO Preferred Practice Pattern: other classes for long-term IOP reduction

“Other glaucoma medications used to provide long-term IOP reduction include alpha2 adrenergic agonists, parasympathomimetics, rho-kinase inhibitors, and topical and oral carbonic anhydrase inhibitors.” (opens the source at this quote in a new tab)

AAO Preferred Practice Pattern: expected IOP reduction by class

Drug classification (agents)	IOP reduction
Alpha-2 adrenergic agonists (apraclonidine, brimonidine)	“20%–25%”
Parasympathomimetic agents (pilocarpine, echothiophate)	“20%–25%”
Rho kinase inhibitors (netarsudil)	“10%–20%”
Topical carbonic anhydrase inhibitors (brinzolamide, dorzolamide)	“15%–20%”
Oral carbonic anhydrase inhibitors (acetazolamide, methazolamide)	“20%–30%”

Adding medications: incremental IOP reduction

“Addition of a second, third, or fourth glaucoma medication has been shown to result in an incremental reduction in IOP, but the effect is usually smaller than for the first medication.” (opens the source at this quote in a new tab)
“A study evaluating the IOP following a pre-randomization glaucoma medication washout in the HORIZON and COMPASS Trials noted a 24% reduction in IOP with the first medication, whereas each additional drop conferred only about 4% further reduction.” (opens the source at this quote in a new tab)

European Glaucoma Society guidelines: switching and fixed combinations

“If the initial therapy is not effective or the drug is not tolerated, one should switch to another monotherapy (in the same or another class) rather than adding a second drug.” (opens the source at this quote in a new tab)
“Multiple topical treatments may reduce adherence and increase exposure to preservatives. Therefore, fixed combination therapy, when available, is preferable to two separate instillations of agents.” (opens the source at this quote in a new tab)
“Combination therapy is not recommended as first choice treatment.” (opens the source at this quote in a new tab)

NICE NG81: escalation to another therapeutic class

“a medicine from another therapeutic class (a beta-blocker, carbonic anhydrase inhibitor or sympathomimetic); topical medicines from different therapeutic classes may be needed at the same time to control IOP or” (opens the source at this quote in a new tab)
“Latanoprost–netarsudil is recommended as an option in NICE technology appraisal guidance for reducing IOP in adults with primary open-angle glaucoma (COAG) when a PGA alone has not reduced IOP enough, only if they have then tried a fixed-dose combination treatment and it has not reduced IOP enough, or a fixed-dose combination treatment containing beta-blockers is unsuitable.” (opens the source at this quote in a new tab)