Open-angle glaucoma
Chronic progressive optic neuropathy with characteristic optic disc changes and visual field loss. The anterior chamber angle is open. Elevated intraocular pressure is the main modifiable risk factor.
ICD-10 H40.15 drugs
Also known as: POAG, Primary open-angle glaucoma
Drugs used for this condition
- ABimatoprostFirst line · Topical prostamide / prostaglandin F2α analogue for ophthalmic useBimatoprost is a first-line prostaglandin analogue for primary open-angle glaucoma. EGS 2024 and SEG/SEO 2023 include it in starting monotherapy: a single evening instillation lowers IOP by 27–33% with a 24-hour effect. The Cochrane 2014 review (Li et al.) groups bimatoprost with latanoprost and travoprost in IOP-lowering efficacy but with a higher rate of conjunctival hyperaemia. If target IOP is not reached within 4–6 weeks, a second agent or a fixed combination is added.
- ABrimonidineSecond line · Topical selective α2-adrenergic agonist for ophthalmic useBrimonidine is used as second-line monotherapy or as add-on to a prostaglandin when IOP control is insufficient. EGS 2024 and SEG/SEO 2023 recommend brimonidine as an alternative or adjunct, especially when beta blockers are contraindicated (COPD, asthma, bradycardia). IOP reduction is 18–25% with 2–3 daily instillations. A possible neuroprotective effect on retinal ganglion cells is discussed but not firmly confirmed by RCTs.
- ADorzolamideSecond line · Topical carbonic anhydrase II inhibitor for ophthalmic useDorzolamide is a second-line topical carbonic anhydrase inhibitor for primary open-angle glaucoma. EGS 2024 and SEG/SEO 2023 recommend it as monotherapy for patients with contraindications to prostaglandins and beta blockers or as add-on when IOP control is insufficient. IOP reduction of 14–20% is weaker than with prostaglandins. Frequently used in a fixed combination with timolol (Cosopt) for two-mechanism synergy.
- ATimololFirst line · Topical non-selective beta blocker for ophthalmic useTimolol is a topical beta blocker, historically first line for primary open-angle glaucoma before prostaglandins, now second-line monotherapy or add-on. EGS 2024 and SEG/SEO 2023 recommend timolol as an alternative to prostaglandins, especially when these are contraindicated (history of uveitis) or in fixed combinations (Cosopt with dorzolamide, Ganfort with bimatoprost). IOP reduction of 20–25%. Use with caution in patients with COPD, asthma, bradycardia and AV block.
- ATravoprostFirst line · Topical prostaglandin F2α analogue for ophthalmic useTravoprost is a first-line prostaglandin F2α analogue for primary open-angle glaucoma. EGS 2024 and SEG/SEO 2023 position prostaglandins as starting monotherapy: a single evening instillation lowers IOP by 25–32% with 24-hour effect. The Cochrane 2014 review (Li et al.) found travoprost comparable to latanoprost and bimatoprost. If target IOP is not reached within 4–6 weeks, a second agent (beta blocker, carbonic anhydrase inhibitor or α2-agonist) is added.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit