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Prostaglandin Analogues

Prostaglandin analogues are currently generally considered our “first line” medications. They have become “first line” by virtue of several aspects. Once daily dosing (usually recommended to be instilled in the evening), along with an impressive pressure decrease (typically at least 20-30% from baseline), as well as a very favorable side effect profile. All of the medications in this group have the ability to increase eyelash length and thickness, darken eye (iris) color, increase pigmentation of the skin surrounding the eye (raccoon eyes), and cause “red” eyes. However, there are usually no systemic side effects.

Prostaglandin analogue medicines work by slowly changing the biology of the wall of the eye. Over time (usually within 2 months of starting therapy), the sclera (or eye wall) becomes more porous the fluid that is secreted into the eye. This allows more fluid to exit from the eye and the pressure decreases.

The 3 currently available medications in this group are:

Xalatan is the first prostaglandin analogue released and is available as of 3/11/11 in its generic form latanoprost.

Lumigan (bimatoprost) may be our most powerful anti-glaucoma medication, however, many people notice the “raccoon eyes” as a significant side effect. In addition, the increase in eyelash length and thickness is so noticeable with this medication that a cosmetic formulation is now available to promote that effect (Latisse).

Travatan Z (Travoprost) has a similar side effect profile and effectiveness as Lumigan (bimatoprost) however, is preserved with Sofzia (boric acid, propylene glycol, sorbitol, zinc chloride) rather than benzalkonium chloride, which is what Xalatan (latanoprost) and Lumigan (bimatoprost) use as a preservative. Certain patients develop a sensitivity to benzalkonium chloride and can tolerate this medication when the other two cannot be used.