Medical Treatment of Glaucoma
BAK-free and Preservative-free options
- The goal of topical therapies is to preserve visual function by
lowering intraocular pressure (IOP) below a level that is likely to
produce further damage to the optic nerve.
- The growth in available agents for the medical treatment of glaucoma
has increased dramatically over the years.
- It is important to note that no individual medication can be used in
all patients in all circumstances. The goals of therapy are
preserving function with the lowest risk, fewest adverse or undesirable
effects, and least disruption of the patient's life.
- An initial reduction in the intraocular pressure of 20% from
baseline is suggested.
- Patients with more advanced disease on initial presentation
require lower initial reductions to prevent further progression and
- The reduction of IOP to the target pressure range does not guarantee
that progression will not occur. Therefore, the target pressure range
needs to be constantly reassessed and changed as dictated by IOP
fluctuations, optic nerve changes, and/or visual field progression.
- Generic versions of these topical products do not have to prove
bioequivalence or equal effectiveness. Data is generally not available
for guidance on selection.
- Topically administered glaucoma medications can have significant
systemic absorption. Patients must be instructed on the proper
administration techniques to reduce the risk of systemic adverse
The program will provide a list of medications for a particular group,
common side effects, and other comments that help with selection of a
Select 'Yes' for additional info
BAK-Free Products (not preservative-free):
- Aung T, Chan YH, Chew PT, et al. Degree of angle closure and the
intraocular pressure-lowering effect of latanoprost in subjects with
chronic angle closure glaucoma. Ophthalmology 2005;112:267-71.
- Chabi A, Varma R, Tsai JC, et al. Randomized clinical trial of the
efficacy and safety of preservative-free tafluprost and timolol in
patients with open-angle glaucoma or ocular hypertension. Am J
- Fingeret M, Gaddie IB, Bloomenstein M. Latanoprostene bunod ophthalmic
solution 0.024%: a new treatment option for open-angle glaucoma and ocular
hypertension. Clin Exp Optom. 2019;102(6):541-550. doi:10.1111/cxo.12853.
- Fraunfelder FT, Bagby GC. Possible hematologic reactions associated
to carbonic anhydrase inhibitors. JAMA 1989;261:2257.
- Fraunfelder FT, Meyer SM. Systemic adverse reactions in glaucoma
medications [review]. Int Ophthalmol Clin 1989;29:143-6.
- Katz LJ, Cohen JS, Batoosingh AL, et al. Twelve-month, randomized,
controlled trial of bimatoprost 0.01%, 0.0125%, and 0.03% in patients
with glaucoma or ocular hypertension. Am J Ophthalmol 2010;149:661-71.
- Krupin T, Liebmann JM, Greenfield DS, et al. Low-Pressure Glaucoma
Study Group. A randomized trial of brimonidine versus timolol in
preserving visual function: results from the Low-Pressure Glaucoma
Treatment Study. Am J Ophthalmol 2011;151:671-81.
- Lewis RA, Katz G, Weiss MJ, et al. Travoprost 0.004% with and
without benzalkonium chloride: a comparison of safety and efficacy. J
- Li T, Lindsley K, Rouse B, et al. Comparative Effectiveness of First-Line
Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network
Meta-analysis. Ophthalmology. 2016;123(1):129-140.
- Lippa EA, Carlson LE, Ehinger B, et al. Dose-response and duration
of action of dorzolamide, a topical carbonic anhydrase inhibitor. Arch
- Liu JH, Kripke DF, Weinreb RN. Comparison of the nocturnal effects
of once-daily timolol and latanoprost on intraocular pressure. Am J
- Parrish RK, Palmberg P, Sheu WP, et al. A comparison of latanoprost,
bimatoprost, and travoprost in patients with elevated intraocular
pressure: a 12-week, randomized, masked-evaluator multicenter study. Am
J Ophthalmol 2003;135:688-703.
- Sherwood MB, Craven ER, Chou C, et al. Twice-daily 0.2%
brimonidine-0.5% timolol fixed-combination therapy vs monotherapy with
timolol or brimonidine in patients with glaucoma or ocular hypertension.
Arch Ophthalmol 2006;124:1230-8.
- Strahlman ER, Tipping R, Vogel R. A six-week dose-response study of
the ocular hypotensive effect of dorzolamide with a one-year extension.
Am J Ophthalmol 1996;122:183-94.
- Thygesen J. Glaucoma therapy: preservative-free for all?. Clin
Ophthalmol. 2018;12:707-717. Published 2018 Apr 13.