An evolution in glaucoma therapy is underway, shifting from a reliance solely on medication and surgery, to a greater understanding
of disease pathology and risk factors in the conversion of ocular hypertension to glaucoma. In addition, there is a growing
interest in new diagnostic technologies that will facilitate evaluation of the optic nerve, nerve fibre layer and macula,
said Dr Murray Fingeret, FAAO, at SECO 2012.
Amid these developments, medical therapy remains the mainstay of glaucoma therapy. Although it's presently a fallow period
for significant changes, one noticeable trend is the introduction of non-preserved agents, noted Dr Fingeret, who is chief,
optometry section, Veterans Administration New York Harbor Health Care System, and clinical professor, State University of
New York College of Optometry, New York, USA.
Earlier this year, the FDA approved two preservative-free glaucoma medications, tafluprost ophthalmic solution 0.0015% (Zioptan,
Merck) and dorzolamide hydrochloridetimolol maleate ophthalmic solution (Cosopt PF, Merck).
Tafluprost is the first preservativefree prostaglandin analogue. Dorzolamide hydrochloride-timolol maleate is a fixed combination
containing a carbonic anhydrase inhibitor and beta-adrenergic receptor blocking agent.
"The question is whether this is a leap forward in terms of efficacy, and we really don't know yet," he said. Tafluprost is
expected to be comparable in IOP-lowering efficacy to other prostaglandins, with fewer effects on the ocular surface.
A plus for compliance?
Dr Fingeret noted that both new drugs are packaged in unit doses, with the cost and 'hassle' of using single-dose vials potentially
influencing patient compliance.
"If they have enough motivation, patients will use them, while others may not want to," Dr Fingeret said. "One potential advantage
is in having one vial for each day; this will prevent patients from using too many drops and running out before the month