Pharmaceutical treatment of primary open angle glaucoma

Abstract Background: Glaucoma is a progressive, irreversible optic neuropathy that results in serious vision loss and blindness. This review aimed to summarize key concepts of primary open angle glaucoma (POAG) pharmaceutical treatment trials over the last decade. Methods: We searched PubMed/MEDLINE and clinicaltrials.gov from January ۱, ۲۰۱۰, to August ۳۱, ۲۰۲۰, using the key words “POAG” and “Ocular topical therapeutics”. This search yielded ۷۷ and ۱۲۰ papers, respectively. Results: Thirty-three records were compatible with our inclusion criteria. Pharmaceutical treatment is a common intervention in POAG for lowering IOP. Prostaglandin (PG) analogues are most commonly recommended as initial medical therapy, which are administrated either as a monotherapy or in combination with other IOP-lowering classes of medications. Alternative therapies, such as ?-blockers, ?-۲ adrenergic receptor agonists, and topical carbonic anhydrase inhibitors, have been used in combination or as a monotherapy. Rho-kinase inhibitors, such as netarsudil ۰.۰۲%, AR-۱۳۳۲۴ ۰.۰۲%, and ripasudil are new IOP-lowering medications. Despite IOP reduction, there is a significant number of patients with POAG that may experience disease progression, and the risk of blindness over the long term is considerable. Conclusions: Clinical trials have indicated that pharmaceutical treatment of POAG is effective and safe. In addition, the new novel Rho-kinase inhibitors have shown significant IOP reduction. The new fixed combinations have also yielded significant reductions in IOP. POAG is a cause of irreversible vision loss, if not diagnosed and treated early. The condition is likely to progress in a significant number of patients, with a considerable risk of blindness in the long-term. Keywords: primary open angle glaucoma POAG intervention study randomized clinical trials RCTs drug therapies pharmaceutical treatment medical therapy prostaglandin analogues beta adrenergic blockers carbonic anhydrase inhibitor Rho-kinase inhibitor Alpha-۲ adrenergic receptor agonist