From the Guidelines
Prostaglandin analogs, such as latanoprost, travoprost, and bimatoprost, are generally considered to have the least side effects among glaucoma medications, as they have minimal systemic impact and are well-tolerated. These once-daily drops work by increasing the outflow of fluid from the eye, effectively lowering intraocular pressure. While they may cause local side effects like eyelash growth, darkening of the iris or eyelid skin, and mild redness or irritation, they rarely cause the breathing problems, fatigue, or depression sometimes associated with beta-blockers like timolol 1.
Key Considerations
- Prostaglandin analogs are the most frequently prescribed initial eye drops for lowering IOP in patients with glaucoma because they are most efficacious, well-tolerated, and instilled once daily 1.
- Topical beta-blockers, such as timolol, may cause systemic effects like bradycardia, especially in the elderly, and are not typically the first-line treatment for glaucoma due to these potential side effects 1.
- The choice of therapy should be individualized, taking into account the patient's age, preferences, degree of ocular damage, and comorbidities, such as asthma, chronic obstructive pulmonary disease, cardiac arrhythmia, or depression 1.
Recommendations
- For patients concerned about side effects, starting with a prostaglandin analog at bedtime (one drop in the affected eye) is often the first-line approach.
- Individual responses vary, and some patients may tolerate other classes better, so working closely with an eye doctor to find the optimal medication is essential.
- It is crucial to weigh the benefits and risks of each medication and consider the patient's overall health and preferences when selecting a glaucoma treatment.
From the FDA Drug Label
In these studies, timolol maleate ophthalmic solution was generally well tolerated and produced fewer and less severe side effects than either pilocarpine or epinephrine. The timolol eye drops have the least side effects compared to pilocarpine or epinephrine for glaucoma treatment, as they produced fewer and less severe side effects in clinical studies 2.
- Key points:
- Timolol was generally well tolerated
- Produced fewer side effects than pilocarpine or epinephrine
- Had less severe side effects than pilocarpine or epinephrine
From the Research
Glaucoma Eye Drops with the Least Side Effects
- The prostaglandin analogs, such as latanoprost, travoprost, bimatoprost, and tafluprost, are considered to be the first-line eye drops for glaucoma treatment due to their efficacy in reducing intraocular pressure 3.
- These medications have a different mechanism of action than other ocular hypotensives, acting primarily by increasing uveoscleral outflow, which results in a substantial additive effect when used with other agents 4, 5.
- Local side effects of prostaglandin analogs include mild conjunctival hyperemia, local irritation, darkening of iris color, and increased growth of eyelashes 4, 5.
- Latanoprost has been shown to be well tolerated, with no systemic side effects proven to be caused by the medication 4, 6.
- Travoprost, another prostaglandin analog, has been found to be equal or superior to latanoprost in lowering intraocular pressure, with a similar safety profile 7.
- Omidenepag, a prostanoid EP2 agonist, has been launched in Japan and has shown comparable intraocular pressure reduction to FP agonists, but with a different safety profile due to differences in intracellular signaling pathways 3.
Comparison of Side Effects
- Iris pigmentation change was observed in 5.0% of patients receiving travoprost 0.0015%, 3.1% of patients receiving travoprost 0.004%, and 5.2% of patients receiving latanoprost 7.
- The average ocular hyperemia score was less than 1 on a scale of 0 to 3 for all treatment groups, indicating that patients experienced between none/trace and mild hyperemia 7.
- Latanoprost caused a possible or definite increase in iris pigmentation in 12% of patients, all of whom had multicolored irides at baseline 6.