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.