Page 46 - 21st Century Perspective - Glaucoma Supplement

Cosopt, a combination of 0.5% timolol and 2% dorzolamide, comes in a preserved multidose bottle
and in a preservative-free unit dose delivery system. Our experience has been that the unit dose
rendition is priced close to the bottled version. When the cost is close, we always go with the
preservative-free option.

Both combination drugs combine either a once-daily drop or twice-daily drop with a drop that is
FDA-approved for three-times-daily dosing.

It has been our observation that brimonidine slightly outperforms a topical carbonic anhydrase
inhibitor; therefore, when we are forced to use a combination drug, we tend to prescribe Combigan.
However, if the ocular surface is significantly compromised, we typically prescribe preservative-free
Cosopt (timolol/dorzolamide).

Prescribing glaucoma medication can be like playing a chess game — one must consider the impact
of every therapeutic move.

Simbrinza

Last, we will look at Simbrinza, a medication that does not contain a beta-blocker but includes the
ingredient drugs of brimonidine 0.2% and brinzolamide 1% ophthalmic suspension. Both ingredient
drugs are approved for three-times-daily use, but in practical usage, they are widely prescribed twice
daily — early in the morning and mid- to late afternoon. As a suspension, Simbrinza must be shaken
well before each instillation.

The perfect scenario for use of Simbrinza would be in a patient who did not respond to timolol, or in
a patient with significant asthma and a clinical need to use both ingredient medications as evidenced
by successful therapeutic trials of each individual ingredient drug.

It is clear, then, that prescribing for glaucoma can be quite simple or it can be incredibly complex, but
it is our duty and obligation to patients to be knowledgeable, thoughtful and always patient-centric in
our prescribing behavior.

Summary

In summary, we initiate IOP-lowering therapy with one of these three medications: Vyzulta, a regular

prostaglandin (almost always latanoprost) or timolol, all depending on multiple patient
characteristics.

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