Control of intraocular pressure fluctuation: are combination drugs more effective?

Evaluation of: Spaeth GL, Bernstein P, Caprioli J, Schiffman RM. Control of intraocular pressure and fluctuation with fixed-combination brimonidine–timolol versus brimonidine or timolol monotherapy. Am. J. Ophthalmol. 151(1), 93–99.e4 (2011).Lowering intraocular pressure (IOP) is fundamental in the treatment of glaucoma, as it is the only therapy demonstrated to slow progression of disease. IOP fluctuation, however, may be more complex and its role in glaucoma is not clear. Recent advances have resulted in fixed-combination drugs, which improve compliance with better efficacy than monotherapy of the components separately. This study compares the effect of fixed-combination brimonidine–timolol to timolol alone and brimonidine alone on IOP lowering and IOP fluctuation. This article demonstrates that the fixed combination lowers IOP and reduces intraday (daytime) and interday fluctuation more than either component alone. The combination may be useful as a step therapy from either of the individual components.