Are all glaucoma drugs equally effective?

Purpose It is only in the recent years that we have got evidence that reducing intraocular pressure (IOP) is beneficial in terms of preventing glaucoma progression in all types of glaucomatous disease. Nowadays we do have numerous data from large clinical outcomes trials clearly indicating that the lower the IOP the better the visual field preservation. There is, however, less data available comparing outcomes of different pharmacological regimen. Methods Only few head‐to‐head comparisons of two drugs that are equally effective in lowering IOP have been published. It is generally assumed that such trials would yield similar results in visual field preservation with both regimen. Looking into the literature there is, however, some evidence for the opposite. Results One clinical trial indicates that betaxolol may be superior to timolol in terms of visual field perservation. Another trial indicates that a combination of dorzolamide and timolol is assocaited with less visual field detoriation than a combination of brinzolamide and timolol. In this study the risk of disease progression was closely linked to low blood velocities in retrobulbar vessels. Conclusion In light of these results and the lessons we have learned from other fields there is a need for further studies comparing the outcomes of different antiglaucoma drugs head‐to‐head. Given that the pathophysiology of glaucoma is only poorly understood it can not generally be expected that all glaucoma drugs are equally effective in perserving visual fields.Commercial interest