Tailoring Pharmacological Therapy for the Progressing Primary Open-angle Glaucoma Patient – What Is the Best Approach?

Glaucoma progression can lead to a significant economic burden and reduction in quality of life. Primary open-angle glaucoma (POAG) is the most common form of this condition, and intraocular pressure (IOP) reduction in POAG patients can either delay or stop disease progression. POAG treatment aims to preserve visual function and quality of life (QoL) by lowering the IOP to the target level needed to limit progression. Importantly, the decision to treat and treatment choice should be based on a patient-tailored approach to optimise treatment outcomes. Commonly used IOP-lowering medications include the first-line prostaglandin analogues/prostamides and β-blockers. POAG patients are initially treated with monotherapy; however, they often experience disease progression due to inadequate IOP reduction. In such cases, combination therapy may be considered to achieve better IOP lowering. Fixed combinations of IOP-lowering medication are highly preferred over unfixed preparations as the former are associated with better patient compliance to treatment. Among the fixed combinations, long-term data for the latanoprost/timolol fixed combination (LTFC, once daily [QD]) is now available, showing LTFC to be effective, well-tolerated and safe over a three-year period in glaucoma patients who did not achieve the target IOP with monotherapy. In addition, LTFC may allow effective treatment tailoring as it has IOP-lowering effects whether dosed in the morning or the evening.