#5: Prostaglandin Analogues for Glaucoma Treatment

Although numerous risk factors have been identified for the treatment of glaucoma, the only one that can currently be effectively managed is intraocular pressure (IOP).

Introduced in the United States and Europe in the late 1990s as second-line glaucoma therapy, prostaglandin analogues rapidly replaced topical beta blockers as first-line IOP-lowering agents, mostly because of their potency, improved systemic side-effect profile, and once-daily dosing. Prostaglandin analogues are currently used in patients with primary open-angle glaucoma, normal-tension glaucoma, chronic closed-angle glaucoma, pigment dispersion syndrome, and exfoliation glaucoma.

Four prostaglandin analogues are now available: bimatoprost, latanoprost, tafluprost, and travoprost. Meta-analyses have found prostaglandins to be more effective than beta blockers, carbonic anhydrase inhibitors, and alpha-adrenergic agonists for the treatment of open-angle glaucoma. Although the exact mechanism of action of prostaglandin analogues remains unknown, it is believed that these drugs improve the uveoscleral pathway by altering the ciliary body and scleral architecture.

Analysis of the optic nerve head with SPECTRALIS(R) Glaucoma Module Premium Edition

In clinical trials, latanoprost, travoprost, and tafluprost have demonstrated an IOP-lowering ability of 25% to 32%, while bimatoprost has been shown to lower IOP by 27% to 33%. In recent years, combination regimens that include a prostaglandin analogue and a beta blocker have become available both in the United States and Europe.

Common side effects of prostaglandin analogues include conjunctival hyperemia, eye irritation, increase in the number and length of eyelashes, and changes in iris and lash pigmentation.

Eye care professionals use a variety of instruments, including imaging devices, to help diagnose glaucoma and assess any improvements following the initiation of prostaglandin therapy. Heidelberg Engineering’s SPECTRALIS Glaucoma Module Premium Edition, for instance, has just received FDA clearance to market. It provides a comprehensive analysis of the optic nerve head, retinal nerve fiber layer, and ganglion cell layer by precisely matching unique scan patterns to the fine anatomic structures relevant in glaucoma diagnostics.