From the Guidelines
The recommended treatment for ocular hypertension typically begins with regular monitoring if the risk of progression to glaucoma is low, but for patients with higher risk factors, topical eye drops are the first-line treatment, aiming to lower intraocular pressure by at least 20% from baseline to reduce the risk of developing glaucoma, as supported by the Ocular Hypertension Treatment Study 1.
Treatment Options
- Topical eye drops, including:
- Prostaglandin analogs (like latanoprost, travoprost, or bimatoprost) used once daily in the evening, which work by increasing aqueous humor outflow
- Beta-blockers (such as timolol 0.25-0.5% twice daily) reducing aqueous humor production
- Alpha-2 agonists (brimonidine 0.1-0.2% two to three times daily)
- Carbonic anhydrase inhibitors (dorzolamide 2% or brinzolamide 1% two to three times daily)
- Combination medications for enhanced efficacy
Considerations
- The choice of medication depends on individual factors including efficacy, side effect profile, cost, and patient adherence potential
- Regular follow-up appointments are essential to monitor intraocular pressure, assess medication effectiveness, and watch for progression to glaucoma
- Lifestyle modifications like regular exercise and avoiding steroid medications when possible may also help manage ocular hypertension
- Laser trabeculoplasty is an alternative therapy to medications in patients with ocular hypertension, as shown in the Selective Laser Trabeculoplasty Versus Eye Drops for the First-line Treatment of Ocular Hypertension and Glaucoma (LiGHT) trial 1
Key Findings
- More than 90% of patients with untreated ocular hypertension did not progress to glaucoma over 5 years, but treatment to lower IOP reduced the risk of developing POAG from 9.5% to 4.5% 1
- Latanoprost is more effective than dorzolamide in lowering IOP, as found in a network meta-analysis for clinical practice guidelines 1
From the FDA Drug Label
Timolol Maleate Ophthalmic Solution is indicated in the treatment of elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma. Dorzolamide HCl Ophthalmic Solution is indicated in the treatment of elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma.
The recommended treatment for ocular hypertension includes the use of certain medications, such as:
- Timolol (2)
- Dorzolamide (3) These medications are indicated for the treatment of elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma.
From the Research
Treatment Options for Ocular Hypertension
The recommended treatment for ocular hypertension typically involves the use of medications that reduce intraocular pressure (IOP). Some of the most commonly used medications include:
- Prostaglandin analogs, such as latanoprost, bimatoprost, and travoprost, which reduce IOP by increasing uveoscleral outflow 4, 5, 6
- Beta-blockers, such as timolol, which reduce IOP by decreasing aqueous humor production 4, 7
- Carbonic anhydrase inhibitors, such as dorzolamide, which reduce IOP by decreasing aqueous humor production 4, 5
- Alpha agonists, such as brimonidine, which reduce IOP by decreasing aqueous humor production and increasing uveoscleral outflow 4, 5
Efficacy of Prostaglandin Analogs
Prostaglandin analogs have been shown to be effective in reducing IOP in patients with ocular hypertension and glaucoma. Studies have demonstrated that latanoprost, bimatoprost, and travoprost are at least as effective as timolol in reducing IOP 4, 5, 7, 6. Additionally, prostaglandin analogs have been shown to have a favorable safety profile, with minimal systemic side effects 4, 5, 7.
Combination Therapy
In some cases, combination therapy may be necessary to achieve adequate IOP reduction. Fixed combinations of latanoprost and timolol have been shown to be more effective than monotherapy with either medication alone 4, 5. Additionally, prostaglandin analogs can be used in combination with other medications, such as carbonic anhydrase inhibitors and alpha agonists, to achieve additive IOP reduction 5, 6.
Emerging Therapies
Newer therapies, such as latanoprostene bunod and NCX 470, which are NO-donating derivatives of latanoprost and bimatoprost, respectively, have shown promise in reducing IOP in patients with ocular hypertension and glaucoma 8. These medications may offer improved efficacy and safety profiles compared to existing therapies.