Modalities for the treatment of primary open-angle glaucoma

J.G. Oganezova¹, S.V. Simonova²

¹Pirogov Russian National Research Medical University, Moscow, Russian Federation

²State Budgetary Institution “Research Institute for Healthcare Organization and Medical
 Management of Moscow Healthcare Department”, Moscow, Russian Federation

Meta-analysis demonstrates that the number of patients with glaucoma worldwide is estimated to be 65.5 million in 2020 and 111.8 million in 2040. Glaucoma requires careful evaluation of the risks and benefits of topical medications for a certain patient considering ocular status and disease stage, potential drug intolerance, allergic reactions, and long-term glaucoma treatment complications. Therefore, the primary goal is to sel ect a medication with excellent IOP-lowering effect and neuroprotective properties whose components prevent complications including dry eye syndrome. The article presents experimental and clinical data fr om different years on drugs with similar activity. Among these agents, selective alpha2-adrenoreceptor agonists are the most promising medications. Clinical trials on brimonidine demonstrate its direct neuroprotective effect which is independent of its IOP-lowering effect (i.e., cell survival improves even in ocular hypertension until IOP is well-controlled). When switching to brimonidine, greater IOP-lowering effect can be explained by its dual action, i.e., a decrease in aqueous flow and an increase in uveoscleral outflow. Luxfen ( 0.2% brimonidine) contains polyvinyl alcohol. The benefits of polyvinyl alcohol presence in ophthalmic solution are its moisturizing and protective effects on the ocular surface. Polyvinyl alcohol prevents dry eye in long-term treatment when adding brimonidine.

Keywords: glaucoma, primary open-angle glaucoma, neuroprotection, dry eye syndrome, compliance, alpha2-adrenoreceptor agonists, brimonidine.

For citation: Oganezova J.G., Simonova S.V. Modalities for the treatment of primary open-angle glaucoma. Russian Journal of Clinical Ophthalmology. 2019;19(3):159–162.