Medical treatment of glaucoma and the promising perspectives

Although great progress has been made in defining the spectrum of diseases known as glaucoma, its pathogenesis is still poorly understood. One common element seems to be the rise of intraocular pressure (IOP) beyond physiologic limits. The lowering of the existing IOP is accomplished either pharmacologically or surgically by decreasing the production of aqueous humor or by increasing aqueous humor outflow facility. Quite a number of pharmacologic agents are available to decrease IOP through distinctly different mechanisms. Since these drugs have their own mechanisms of action, some are used in combination in attempts to reduce the IOP to acceptable levels that will stabilize the optic nerve head excavation or the visual fields. In most patients with glaucoma beta-blockers are the treatment of initial choice. However, in almost 50% of these individuals therapy with beta-blockers alone does not reduce IOP adequately. Therefore, there is a need for new classes of topical IOP-lowering agents that can be used alone or in a combination with beta-blockers. This review summarizes the possible perspectives of some of the antiglaucomatous drugs that have been introduced in 1995 as well as those still under clinical investigation.