Available Agents and Dosing Frequency
Currently, 5 prostaglandin analogues are in widespread clinical use: (1) latanoprost, (2) travoprost, (3) bimatoprost, (4) tafluprost, and (5) latanoprostene bunod. These agents reduce IOP by 25%–33%. Tafluprost appears to be slightly less efficacious than latanoprost (see Table 12-2; see also the section General Approach to Medical Treatment, later in this chapter, for discussion of preservatives). Latanoprostene bunod lowers mean diurnal IOP by 32% and is unique in that it is a nitric oxide–donating PGF2α analogue. Nitric oxide is thought to increase trabecular outflow facility with a resultant 1 mm Hg IOP-lowering advantage over latanoprost in 1 clinical trial. The mechanism of action is discussed in more detail in BCSC Section 2, Fundamentals and Principles of Ophthalmology.
Prostaglandin analogues are used once daily and are less effective when used twice daily. Because some patients may respond better to 1 agent in this class than to another, switching drugs after a trial of 4–6 weeks may sometimes prove helpful.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.