2. Lumigan tends to lower IOP better than Travatan, which lowers IOP better than Xalatan.
3. Lumigan is usually associated with the most conjunctival hyperemia, so I don't usually start Lumigan as first line therapy. If a patient is using another prostaglandin analogue (Travatan or Xalatan), this tends to "prep" the eye and it will not be as hyperemic after switching to Lumigan later on.
4. Azopt tends to be the best secondary agent when combined with a Prostaglandin analogue. This is when compared to other drops like Alphagan or a beta blocker.
5. Alphagan (and Combigan) can cause systemic sedation. Patients may feel "tired or sleepy" when using these eye drops. Make sure you instruct them to do punctal occlusion after drop instillation.
6. Pseudoexfoliative glaucoma responds best to a beta blocker, followed by Prostaglandin
A couple of thoughts:
On the prostaglandins: don't go straight for the "if the Xalatan doesn't work well, go with Travatan" try to know the reasons. Studies are showing that Travatan works better in black patients than Xalatan.
Lumigan causes less of the hyperpigmentation problems with the other 2, less headaches (as symptoms
) but will give more conj hyperemia.Also, recent, recent studies and discussions in glaucoma are moving away from "whichever lowers IOP best" when you can have a low IOP but still have NFL loss. Some studies are recommending for newly diagnosis, use a prostaglandin to get the IOP controlled, then transfer to a Alphagan- as it is a neuroprotectant. I encourage everyone to read new literature on neuroprotectants.
Jack Kanski (love him) has listed several items of interest to prescribe:
Betaxolol, Alphagan, Vit E, and Ginko Biloba. These items have nueroprotective qualities to them, with the drugs having proved VF saving results.
This explains renewed interest in some poly glaucoma drugs as they are incorporating a proven IOP lowering substane with a paired nueroprotectant.
