Glaucoma therapeutics

Medical management remains the initial treatment of choice for most patients with glaucoma. A rational approach to therapy includes assessing the extent of damage, measuring the untreated intraocular pressure (IOP) several times to establish an untreated baseline, and establishing a target IOP. The selection of initial monotherapy must be based on individual factors, but the ocular β-adrenergic antagonists and prostaglandin analogues have become the favored choice for most clinicians. When monotherapy does not sufficiently control IOP, one can switch to a different drug or add a drug. The availability of modern combination therapies can help reduce the burden of therapy for the patient. Although published studies might help guide in the selection of treatment, nothing can replace assessing the effect of the treatment in the individual patient.