What are the first-line medications for glaucoma?

• A. Prostaglandin analogs
• B. Beta blockers
• C. Alpha-adrenergic agonists
• D. Carbonic anhydrase inhibitors

Answer: (A)

Prostaglandin analogs are first-line therapy for glaucoma because they provide the strongest, most convenient reduction in intraocular pressure with minimal systemic effects. They increase the outflow of aqueous humor through the uveoscleral pathway, typically lowering IOP by about 25–35%. Their once-daily dosing, usually at night, makes it easier for patients to adhere to treatment, which is crucial for slowing glaucoma progression.

Other drug classes work differently: beta blockers reduce aqueous production but can cause systemic side effects like low blood pressure and bradycardia; alpha-adrenergic agonists have systemic and local side effects and can lead to tolerance or conjunctival irritation; carbonic anhydrase inhibitors lower production but carry metabolic side effects (such as acidosis) and are often used as add-ons or in specific situations. Because prostaglandin analogs combine strong efficacy, favorable tolerability, and simple dosing, they’re the preferred starting option for most patients with primary open-angle glaucoma.