When would we use a second-line agent?

• A. Adjunctive therapy when lower IOP is needed to achieve target
• B. Primary therapy for all patients
• C. Only after laser therapy
• D. Never used

Answer: (A)

In POAG management, if the initial therapy does not bring the IOP down to the target level, clinicians add a second-line agent as adjunctive therapy to achieve further lowering. This approach uses two medications with different mechanisms to push the IOP lower than either could alone, allowing you to reach the target without overloading a single drug’s tolerance or side effects. It’s not meant as the default for every patient—first-line monotherapy is chosen for simplicity, tolerability, and cost, and escalation with an additional agent is implemented when the target IOP isn’t met or progression occurs. It’s also not restricted to after laser therapy; medications can be added before or after considering laser options depending on the individual case.