What to Add After Prostaglandin Analogs for Glaucoma
Many patients with glaucoma or ocular hypertension require more than one medication to sufficiently lower their intraocular pressure and prevent progression. For patients already on a PGA, the mean diurnal IOP-lowering efficacy of AA, BB, and TCAIs is similar, but the side-effect profiles, nocturnal IOP-lowering efficacy, and trough IOP-lowering effect vary. LTP is an effective approach to further lower the IOP in patients on a PGA. Fixed-combination agents are, on average, more effective than single agents. However, for individual patients, clinicians should verify the additional IOP-lowering efficacy of each component. More work is needed to better characterize additional factors that might influence the choice of adjunctive medical therapies.
Conclusion
Many patients with glaucoma or ocular hypertension require more than one medication to sufficiently lower their intraocular pressure and prevent progression. For patients already on a PGA, the mean diurnal IOP-lowering efficacy of AA, BB, and TCAIs is similar, but the side-effect profiles, nocturnal IOP-lowering efficacy, and trough IOP-lowering effect vary. LTP is an effective approach to further lower the IOP in patients on a PGA. Fixed-combination agents are, on average, more effective than single agents. However, for individual patients, clinicians should verify the additional IOP-lowering efficacy of each component. More work is needed to better characterize additional factors that might influence the choice of adjunctive medical therapies.
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