Is tolerance in glaucoma therapy overestimated and drug effectiveness underestimated? Review article

Abstract

Glaucoma pharmacotherapy is a long-term process in which subjective symptoms (related to medication intolerance) are being reported by patients with increasing frequency. As a result, therapeutic decisions made by clinicians may favor better-tolerated agents, even if they are potentially less effective. Intensification of glaucoma therapy is required when the target intraocular pressure is not achieved. This can be accomplished by adding another medication, switching to a fixed-combination preparation, or replacing the current drug with a more effective agent within the same class. The last approach is particularly relevant for prostaglandin analogues – a group that includes four active substances. Comparative analyses consistently show that bimatoprost provides a statistically significant, though relatively modest, additional intraocular pressure reduction compared with latanoprosts.