Page 28 - 21st Century Perspective - Glaucoma Supplement

Figure 16.​ Timolol ophthalmic solution.

It was nearly 2 more decades until the prostaglandins (beginning with Xalatan [latanoprost, Pfizer])
entered the market, which relegated timolol (and numerous other beta-blockers) largely to
second-tier status. Latanoprost had exclusive status until other prostaglandin competitors entered

the market a few years later.

It has since been another 2 decades, and now a new generation of a nitric oxide-donating
prostaglandin is available for the care of our patients. The options for medical reduction in human
IOP are now more numerous than ever and require us to gain a keener understanding of how all
these drugs best play a role in the enduring care of our patients.

Prostaglandins

Let us take a more detailed look at each of these drug classes and develop a more fine-tuned

appreciation for their strengths and weaknesses. We will start with the most commonly prescribed
class, the prostaglandins. As we shared above, when prostaglandins entered the market in the
mid-1990s, this drug class was the single most beneficial contribution to our modest glaucoma
armamentarium that had been made in decades. Xalatan then, and generic latanoprost now, is the
most commonly prescribed prostaglandin. Despite containing 0.02% benzalkonium chloride (BAK),
latanoprost is the most tolerable medication of this class. Its new mechanism of action of enhancing

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