WHAT SHOULD BE THE DRUG OF CHOICE IN THE TREATMENT OF OPEN ANGLE GLAUCOMA?

A little over two decades ago topical β blockers became the primary treatment for chronic open angle glaucoma. β Blockers replaced cholinergics (primarily pilocarpine) despite the fact that β blockers were seen as considerably more expensive. The advantage of β blockers was their apparent increased effectiveness, and the minimal amount of local side effects. Despite the fact that systemic side effects associated with their use are not inconsiderable, β blockers have remained the drug of choice for initial treatment of chronic open angle glaucoma. A controversy moderated by Ivan Goldberg addresses the question of whether β blockers should now be replaced by some of the newer agents available for treatment of open angle glaucoma. What are these newer agents? They are primarily α₂ agonists, prostaglandin analogues and related drugs, and topical carbonic anhydrase inhibitors. Some of them appear to offer equal or …