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Comparative effectiveness of glaucoma drops

glaucoma treatment


The purpose of this program is to determine possible alternatives for a patient who fails to achieve an intraocular pressure (IOP) target and to provide guidance on more potent alternatives while staying with a single commercial product which includes some combination products.

Key points

  • 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 vision loss.
  • 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 effects.

Select the product the patient is currently receiving that has not achieved the intraocular pressure (IOP) target:

Alphagan® P- Brimonidine tartrate 0.2%
Azopt® -Brinzolamide ophthalmic suspension 1%
Betagan® - Levobunolol HCI 0.25%, 0.5%
Betoptic® -Betaxolol HCI 0.25%, 0.5%
Combigan® (brimonidine tartrate/timolol maleate) [Combination]
Cosopt® - Dorzolomide HCI & Timolol Maleate [Combination]
Lumigan®- Bimatoprost 0.01%, 0.03%
Rhopressa®- Netarsudil 0.02%
Rocklatan® (netarsudil and latanoprost)  [Combination]
Simbrinza® (brinzolamide/brimonidine tartrate) [Combination]
Timoptic® -Timolol maleate 0.25%, 0.5%
Travatan® Z - Travoprost 0.004%
Trusopt® - Dorzolamide HCI 2%
Vyzulta™ -Latanoprostene bunod 0.024%
Xalatan® - Latanoprost 0.005%
Zioptan™ - Tafluprost ophthalmic solution 0.0015%

Potency - Comparative effectiveness


  • Estimated potency based primarily on Li T, Lindsley K, et al.  Additional comments from the various package inserts (clinical trial data) were also used.
  • Medications containing brackets below indicate the mean reductions (95% credible intervals) in IOP in mmHg at 3 months - from Li T, Lindsley K, et al.


  1. 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. doi:10.1016/j.ophtha.2015.09.005

    Conclusions:   All active first-line drugs are effective compared to placebo in reducing IOP at 3 months. Bimatoprost, latanoprost, and travoprost are among the most efficacious drugs, although the within class differences were small and may not be clinically meaningful. All factors, including adverse effects, patient preferences, and cost should be considered in selecting a drug for a given patient.
  2. 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.



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Potency of glaucoma drops