Pearls on the Prostaglandins
• Since it can take two to three weeks to achieve the full
therapeutic effect, schedule the monocular trial no sooner
than two weeks; three weeks is probably the most clinically
practical.
• Since you will obtain multiple IOP readings at different
times of the day prior to initiating therapy, try to have the
patient return for the therapeutic trial evaluation when the
IOP tended to be highest.
• If one prostaglandin medicine fails to achieve target IOP
(or expected reduction in IOP), should you try another prostaglandin?
While there are always anecdotal exceptions to conventional
wisdom, we tend to think glaucoma specialists Richard K. Parrish,
M.D., and Dan Eisenberg, M.D., have it right. In the May 15,
2002, Ophthalmology Times, they write, “Switching from one
drug to another within the same class makes little sense unless
the adverse effect profile has been proven to be different.”
They continue, “If you are thinking of switching drugs in the
same class for IOP control, you should think again x Switching
for decreased adverse effects, when IOP is controlled, is a
reasonable approach.” This makes sense in that most classes
of medicines behave similarly. Look at the non-selective beta-blockers
as an example; switching within this class offers no advantage.
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