Carbonic anhydrase inhibitors (CAIs) have been used for many decades in the treatment of glaucoma. Systemic CAIs were an early treatment option to lower intraocular pressure by reducing aqueous humour production; however, frequent side effects including polyuria and paresthesia contributed to the eventual development of topical CAIs. As topical drug development evolved over time, prostaglandin analogues and beta-blockers have become the gold standard of glaucoma therapies. Although prescribed less often than other classes of topical glaucoma therapies, topical CAIs continue to be used in combination therapies with beta-blockers and alpha agonists. Topical CAIs have also been demonstrated to alter biomarkers of ocular haemodynamics, which have relevance in glaucoma. The purpose of this review is to review and summarise the current state of topical CAI prescribing trends, known efficacy and suggested mechanisms and potential influence on ocular haemodynamics for the future of glaucoma management.
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Contributors All authors made a substantial contribution to the review. Each author participated in drafting or revising the manuscript and approved submission of this version for publication.
Funding AH is supported by NIH grant (R01EY030851) and NSF DMS (1853222/2021192). This work was supported in part by a Challenge Grant award from Research to Prevent Blindness, New York, USA.
Competing interests AH would like to disclose that he received remuneration from AdOM, Qlaris, Luseed and Cipla for serving as a consultant, and he serves on the board of AdOM, Qlaris and Phileas Pharma. AH holds an ownership interest in AdOM, Luseed, Oxymap, Qlaris, Phileas Pharma and QuLent. All relationships listed above are pursuant to Icahn School of Medicine’s policy on outside activities. IJ would like to disclose that she received remuneration from Santen and Thea for serving as a consultant. The contribution of the author Francesco Oddone was supported by Fondazione Roma and by the Italian Ministry of Health. None of the other authors listed have any financial disclosures.
Provenance and peer review Not commissioned; externally peer reviewed.