Prostaglandin analogs in glaucoma

Glaucomatous visual changes and defects are almost irreversible, with the visual field changes of glaucoma being noticed by the patient after significant disease progression due to a relative lack of alerting symptoms. Reduction of elevated intraocular pressure (IOP) is the only as yet proven approach to protect against visual field loss in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). When they first entered the ophthalmic market about 10 years ago, prostaglandins were viewed skeptically as a potential first-line therapy for glaucoma patients. Yet in less than a decade, glaucoma specialists' preferences have changed, with most reporting that they prefer prostaglandins over beta blockers as their patients' initial medication. Latanoprost has truly withstood the test of time and has indeed proved to be one of the best anti-glaucoma medications when used as monotherapy or as adjunctive therapy. Bimatoprost 0.01% has a similar overall safety profile, a favorable hyperemia profile, and less overall discontinuation compared with Bimatoprost 0.03%. In lieu of its poor efficacy, Unoprostone has lost its hold in the anti-glaucoma palate. Travatan Z (travoprost) is a new formulation of Travatan solution in which benzalkonium chloride is replaced with Sofzia, a robust ionic buffered preservative system that is gentle to the ocular surface. Tafluprost, the newest addition to the prostaglandin brigade, is a fluorinated analogue of prostaglandin-F 2α and is available as a sterile ophthalmic solution of 0.0015% (0.015 mg/ml) being approved by the US-FDA on 10th February, 2012. A new futuristic glaucoma therapeutic management paradigm where clinical success is no longer simply measured by achieved level of intraocular pressure control but also long-term preservation of visual function and patient's quality of life is expected to dramatically improve upon current treatment algorithms for ocular hypertension and glaucoma.