Glaucoma is a leading cause of blindness and visual impairment. Treatments that lower intraocular pressure (IOP) tend to delay progression of the condition. However, the target IOP cannot be achieved with monotherapy in many patients. If monotherapy adequately controls IOP and is well tolerated, it should not be changed, but if the therapy is only partially effective, a combination may be used. Combination therapy is eventually needed in many cases of glaucoma. Combinations may be given as adjunctive or preferably as fixed therapies. The mechanism of action and contraindications of the constituent agents should be taken into account when prescribing combinations, for optimal safety and efficacy. As treatment choice expands, prescribing patterns are changing worldwide. Fixed combination therapies are increasingly prescribed in Europe in particular for the treatment of glaucoma. They should be administered according to the current evidence-based guidelines.
AlwardW.L.M.Medical management of glaucoma.N Engl J Med1998; 339: 1298–307.
3.
BoyleJ.E., GhoshK., GieserD.K., AdamsonsI.A., the Dorzolamide-Timolol Study Group. A randomized trial comparing the dorzolamide-timolol combination given twice daily to monotherapy with timolol and dorzolamide.Ophthalmology1998; 105: 1945–51.
4.
KassM.A., HeuerD.K., HigginbothamE.J.The Ocular Hypertension Treatment Study: A randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open angle glaucoma.Arch Ophthalmol2002; 120: 701–13.
5.
HeijlA., LeskeM.C., BengtssonB., BengtssonB., HusseinM., Early Manifest Glaucoma Trial Group. Measuring visual field progression in the Early Manifest Glaucoma Trial.Acta Ophthalmol Scand2003; 81: 286–93.
6.
LichterP.R., MuschD.C., GillespieB.W., for the CIGTS Study Group. Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery.Ophthalmology2001; 108: 1943–53.
7.
BarnebeyH.S., Orengo-NaniaS., FlowersB.E.The safety and efficacy of travoprost 0.004%/timolol 0.5% fixed combination ophthalmic solution.Am J Ophthalmol2005; 140: 1.e1–1.e8.
8.
HoyngP.F.J., KitazawaY.Medical treatment of normal tension glaucoma.Surv Ophthalmol2002; 47(Suppl 1): S116–24.
9.
LiesegangT.J.Glaucoma: Changing concepts and future directions.Mayo Clin Proc1996; 71: 689–94.
10.
LevinL.A.Retinal ganglion cells and neuroprotection for glaucoma.Surv Ophthalmol2003; 48(Suppl): S21–4.
11.
European Glaucoma Society.II Edition: Terminology and Guidelines for Glaucoma 2003.Dogma Editrice: Savona, Italy; 2003.
12.
Popovic-SuicS., SikicJ., VukojevicN., CerovskiB., NasicM., PokupecR.Target intraocular pressure in the management of glaucoma.Coll Antropol2005; 29(Suppl): S149–51.
13.
AGIS Investigators.The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intra-ocular pressure and visual field deterioration.Am J Ophthalmol2000; 130: 429–40.
14.
Danesh-MeyerH.V., KatzL.J.Combination medical therapy in glaucoma management.Compr Ophthalmol Upd2000; 1: 97–108.
SchumanJ.S., KatzG.J., LewisR.A.Efficacy and safety of a fixed combination of travoprost 0.004%/ timolol 0.5% ophthalmic solution once daily for open-angle glaucoma or ocular hypertension.Am J Ophthalmol2005; 140: 242.e1–242.e11.
18.
OsborneN.N., UgarteM., ChaoM.Neuroprotection in relation to retinal ischemia and relevance to glaucoma.Surv Ophthalmol1999; 43(Suppl 1): S102–28.
19.
MigliorS., ZeyenT., PfeifferN., Cunha-VazJ., TorriV., AdamsonsI.Results of the European Glaucoma Prevention Study.Ophthalmology2005; 112: 366–75.
20.
De Saint JeanM., DebbaschC., BrignoleF., RatP., WarnetJ.M., BaudouinC.Toxicity of preserved and unpreserved antiglaucoma topical drugs in an in vitro model of conjunctival cells.Curr Eye Res2000; 20: 85–94.
21.
CostagliolaC., PreteA.D., IncorvaiaC., FuscoR., ParmeggianiF., Di GiovanniA.Ocular surface changes induced by topical application of latanoprost and timolol: A short-term study in glaucomatous patients with and without allergic conjunctivitis.Arch Clin Exp Ophthalmol2001; 239: 809–14.
22.
ChoudhriS., WandM., ShieldsM.B.A comparison of dorzolamide-timolol combination versus the concomitant drugs.Am J Ophthalmol2000; 130: 832–3.
23.
CarrollS.C., GaskinB.J., GoldbergI., Danesh-MeyerH.V.Glaucoma prescribing trends in Australia and New Zealand.Clin Exp Ophthalmol2006; 34: 213–8.
24.
BatemanD.N., ClarkR., Azuara-BlancoA., BainM., ForrestJ.The impact of new drugs on management of glaucoma in Scotland: Observational study.Br Med J2001; 323: 1401–2.
