Ocular Hypertension and Glaucoma
Latanoprost 0.005%: Reduction of elevated IOP in patients with open-angle glaucoma or ocular hypertension.               
Appears to be more effective than unoprostone (not available in US), as effective as travoprost, and slightly less effective than bimatoprost in reducing IOP in patients with open-angle glaucoma or ocular hypertension.     
May be more effective or at least as effective as twice-daily administration of timolol 0.5% in reducing IOP in patients with open-angle glaucoma or ocular hypertension.         Appears to be more effective than thrice-daily administration of dorzolamide 2%. 
Tolerance does not occur, and reduction in mean IOP is maintained for up to at least 24 months of therapy after initial stabilization.        
Fixed-combination netarsudil 0.02% and latanoprost 0.005%: Reduction of elevated IOP in patients with open-angle glaucoma or ocular hypertension. When administered once daily, mean IOP reduction was approximately 1–3 mm Hg greater than that achieved with once-daily administration of either drug alone. 
When selecting an initial ocular hypotensive agent, consider extent of the required IOP reduction, coexisting medical conditions, and drug characteristics (e.g., dosing frequency, adverse effects, cost).  With single-agent regimens, the reduction in IOP is approximately 25–33% with topical prostaglandin analogs; 20–25% with topical β-adrenergic blocking agents, α-adrenergic agonists, or miotic (parasympathomimetic) agents; 20–30% with oral carbonic anhydrase inhibitors; 18% with topical rho kinase inhibitors; and 15–20% with topical carbonic anhydrase inhibitors. 
A prostaglandin analog frequently is considered for initial therapy in the absence of other considerations (e.g., contraindications, cost considerations, intolerance, adverse effects, patient refusal) because of relatively greater activity, once-daily administration, and low frequency of systemic adverse effects; however, ocular adverse effects can occur.   
Goal is to maintain an IOP at which visual field loss is unlikely to substantially reduce quality of life during the patient's lifetime. 
Reduction of pretreatment IOP by ≥25% shown to slow progression of primary open-angle glaucoma.  Set an initial target IOP (based on extent of optic nerve damage and/or visual field loss, baseline IOP at which damage occurred, rate of progression, life expectancy, and other considerations) and reduce IOP toward this goal.   Adjust target IOP up or down as needed over course of disease.  
Combination therapy with drugs from different therapeutic classes often required to control IOP. 
