It was the first beta-blocker approved for topical use in the treatment of glaucoma in the US (1978) ( 7). The mechanism of action of timolol is through reduction in formation of the aqueous humor in the ciliary body in the eye. The higher the level of IOP, the greater is the likelihood of the optic nerve damage and visual field loss ( 4). Studies have suggested that the main mechanism of action is increased uveoscleral outflow. Latanoprost is a prostanoid selective FP receptor agonist that is believed to reduce IOP by increasing the outflow of the aqueous humor. Latanoprost, a Prostaglandin F2 alpha (PGF2α) analog, was approved by the United States Food and Drug Administration (USFDA) in 1996 ( 4). Thus, compliance can be a major issue, which is related to the level of education and socio-economic status of the patient ( 5, 6). Glaucoma medications do not improve vision, may have important side effects, and are relatively expensive. Glaucoma treatment in developing countries should consider clinical, laser, and surgical approaches. The ultimate goal of glaucoma treatment is to slow down disease progression to a rate in which the patient will not experience a vision-related decrease in quality of life ( 5, 6). While half of the population with glaucoma in high-income countries is unaware of their disease, this figure is over 90% in low-income countries, particularly in the rural settings ( 4). Worldwide, approximately 80 million people have been predicted to have glaucoma by the end of 2020, with 11 million being bilaterally blind. Elevated intraocular pressure (IOP) is responsible for glaucoma, and most treatments are designed to reduce IOP ( 3). Open-angle glaucoma may lead to permanent blindness ( 1, 2). Glaucoma is the third leading cause of irreversible blindness worldwide. Latanoprostene bunod was superior to latanoprost and timolol for the treatment of open-angle glaucoma. All treatments had some common adverse ocular effects. The LB cohort had the highest reduction in IOP, compared to the LP and TM cohorts. RESULTS:Īt the end of 3 months of treatment, latanoprost, latanoprostene bunod, and timolol were all successful in reducing IOP. Informed Consent has been taken from each participant before the trial. All treatments were administered to the affected eye(s) for 3 months. Those who received timolol eye drops twice daily were included in the Timolol Maleate (TM) cohort (n=115). Those who received latanoprostene bunod eye drops once daily in the evening were included in the Latanoprostene Bunod (LB) cohort (n=94). Patients who received latanoprost eye drops once daily in the evening were included in the latanoprost Ophthalmic Solutions (LP) cohort (n=104). This study compared the safety and efficacy of latanoprost, latanoprostene bunod, and timolol maleate in patients with open-angle glaucoma. The United States Food and Drug Administration approved latanoprostene bunod, a nitric oxide-donating prodrug of latanoprost, for lowering IOP. Timolol maleate has been reported to be a safer intraocular pressure (IOP) lowering treatment than latanoprost.
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