Efficacy and adverse effects of medications used in the treatment of glaucoma.

With the advent of several new topically active medications for glaucoma th erapy, intraocular pressure (IOP) can be reduced to target levels in more p atients before resorting to surgery. Some of these newer agents have a numb er of advantages over some of the older medications, several of which are s eldom used now; The topically active carbonic anhydrase inhibitors are bett er tolerated than oral formulations, which are infrequently used despite th eir greater efficacy compared with the topical formulations. The alpha(2)-a drenergic agonists effectively reduce IOP with few systemic adverse effects . The prostaglandin analogues are even more effective and well tolerated wh en applied once daily without known systemic adverse effects. The variety of glaucoma medications forces the physician to be selective wi th various combinations before proceeding with surgery. This article critic ally reviews the literature pertaining to the newer glaucoma medications, t hereby providing guidelines to make rational choices from among the availab le options.