Prostaglandin analogs are considered the first-line agents due to their efficacy, convenience (once-daily dosing), and tolerability. They increase uveoscleral outflow, reducing IOP effectively.
Beta-blockers reduce aqueous humor production, thereby decreasing IOP. They are commonly used as first-line or adjunctive therapy, but caution is needed in patients with cardiovascular or respiratory conditions.
Alpha-2 adrenergic agonists reduce aqueous humor production while increasing uveoscleral outflow. They can be used as monotherapy or in combination with other agents.
CAIs decrease aqueous humor production by inhibiting carbonic anhydrase enzymes. They are available in topical, oral, and systemic formulations and can be used as adjunctive therapy.
In cases where monotherapy fails to achieve the target IOP, combination therapy with different classes of medications is often required to provide additive or synergistic effects.
Regular monitoring of IOP and optic nerve health is necessary to assess treatment response and disease progression. Adjustments to medication regimens should be made based on individual patient needs and goals.
In cases of refractory glaucoma or when pharmacotherapy is insufficient, surgical interventions, such as laser trabeculoplasty or filtration surgeries, may be necessary. Collaboration with ophthalmologists is essential for appropriate referral and management.
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