Decreasing eye pressure (IOP) is currently the only way to preserve vision for glaucoma sufferers. Current medications achieve this result by either decreasing aqueous outflow via trabecular or uveoscleral pathways or decreasing aqueous production. An ideal medical solution would provide maximum protection against disease progression along with convenient dosing and minimal side effects. Unfortunately, the simplest therapy, monotherapy, often fails to achieve our IOP-lowering goals.
Prostaglandin analogs and Rho-associated kinase inhibitors have complementary mechanisms of action. Not surprisingly, these drugs have a synergistic effect. They are two of the most potent IOP-reducing medications currently available, and both also offer patients convenient once daily dosing. These drugs are currently available commercially in the fixed combination preparation Rocklatan (netarsudil 0.02%/latanoprost 0.005% ophthalmic solution, Aerie Pharmaceuticals). This combination can be significant, as every 1 mm Hg decrease in IOP can result in a 10% reduction in the risk of glaucomatous progression (Early Manifest Glaucoma Trial, Heijl et al.). While I’m excited to have a new IOP-lowering preparation, the incidence of redness (hyperemia) with the combination in this new study was four times greater than with a prostaglandin analog alone. In our zeal to minimize IOP we must be mindful of side effects that could cause patients to abandon the treatment altogether.
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