September 27, 2016
The initial therapy for standard of care in glaucoma has been topical drops for a very long time. Although we are constantly working on better ways to deliver medications and perform surgery, primary and adjunctive therapies still depend on eye drops. The major obstacle remains the same: patient compliance and the factors that influence it. It is great having more drop options, especially after prostaglandin analogues. Unfortunately, we all know our patients’ ability to effectively get these in their eyes remains the major limiting step. This occurs for many factors. Dosing regimens for topical medications can be complicated, which is further exacerbated if the patient has other systemic diseases requiring oral drugs. Other factors include the side effects beyond those to the eyes that can be quite serious, including systemic, and the inability to effectively apply eye drops.
Patients simply do better when these compounding issues that affect compliance are minimized. However, more than 50% of patients need more than one class of therapy. Every time a patient misses a dose, no matter the reason, there is additional damage to the optic nerve. The cumulative effect can be devastating. Currently, the selection of therapy from adjunctive options is simply a compromise among efficacy, safety and dosing instead of an ideal choice. The ideal situation would include maintaining the patient on just one drop a day like a prostaglandin but getting more IOP reduction. Until recently this has not been possible because current medications have not been combined with prostaglandins in the United States.