Prostaglandin Analogues Versus Topical Beta-Blockers in the Initial Pharmacological Management of Primary Open-Angle Glaucoma: Clinical Effectiveness and the Role of Medication Adherence

Naufal Prama Putra; Ghani Phalosa; Andi Muhammad Fajri Rusdianto

doi:10.69693/ijim.v4i3.1974

Authors

Naufal Prama Putra Republic of Indonesia Defense University
Ghani Phalosa Republic of Indonesia Defense University
Andi Muhammad Fajri Rusdianto Republic of Indonesia Defense University

DOI:

https://doi.org/10.69693/ijim.v4i3.1974

Keywords:

prostagalndin analogues, primary open-angle glaucoma, topical beta-blockers, intraocular pressure, treatment persistence

Abstract

Primary open-angle glaucoma is a progressive optic neuropathy requiring sustained intraocular pressure control to prevent irreversible visual loss. Prostaglandin analogues and topical beta-blockers are widely used pharmacological therapies, although their clinical effectiveness is influenced by efficacy, safety, dosing convenience, and patient adherence. This narrative review compared the clinical effectiveness of both drug classes and examined the role of adherence in long-term treatment outcomes. Literature published primarily between 2021 and 2026 was identified from PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar. Prostaglandin analogues generally provide greater and more sustained intraocular pressure reduction than topical beta-blockers, with once-daily administration offering an additional practical advantage. However, local ocular and periocular adverse effects may reduce treatment acceptance. Topical beta-blockers remain effective alternatives for selected patients, although cardiovascular and respiratory adverse effects require careful consideration. The clinical benefits of both therapies may be reduced by missed doses, incorrect eye-drop administration, adverse effects, treatment cost, and limited medication access. Therefore, prostaglandin analogues are generally preferred as initial pharmacological therapy, whereas topical beta-blockers remain appropriate for selected patients based on tolerability, comorbidities, accessibility, and the likelihood of sustained adherence.

Downloads

Download data is not yet available.

References

Aftab, O. M., Khan, H., Sangani, R., & Khouri, A. S. (2024). A national analysis of systemic adverse events of beta-blockers used for glaucoma therapy. Cutaneous and Ocular Toxicology, 43(4), 293–298. https://doi.org/10.1080/15569527.2024.2402408

Aihara, M. (2021). Prostanoid receptor agonists for glaucoma treatment. Japanese Journal of Ophthalmology, 65(5), 581–590. https://doi.org/10.1007/s10384-021-00844-6

Almidani, L., Pan, A., Bradley, C., Pham, A., & Yohannan, J. (2026). The effect of medication adherence on intraocular pressure and glaucoma progression. Ophthalmology Glaucoma, 9(2), 158–165. https://doi.org/10.1016/j.ogla.2025.10.003

Asrani, S. G., McGlumphy, E. J., Al-Aswad, L. A., Chaya, C. J., Lin, S., Musch, D. C., Pitha, I., Robin, A. L., Wirostko, B., & Johnson, T. V. (2024). The relationship between intraocular pressure and glaucoma: An evolving concept. Progress in Retinal and Eye Research, 103, Article 101303. https://doi.org/10.1016/j.preteyeres.2024.101303

Baudouin, C., Myers, J. S., Van Tassel, S. H., Goyal, N. A., Martinez-de-la-Casa, J., Ng, A., & Evans, J. S. (2025). Adherence and persistence on prostaglandin analogues for glaucoma: A systematic review and meta-analysis. American Journal of Ophthalmology, 275, 99–113. https://doi.org/10.1016/j.ajo.2025.03.025

Benitez, B., Anter, A. M., Arcuri, J., & Bhattacharya, S. K. (2024). Currently available prostanoids for the treatment of glaucoma and ocular hypertension: A review. Current Opinion in Pharmacology, 74, Article 102424. https://doi.org/10.1016/j.coph.2023.102424

Bott, D., Subramanian, A., Edgar, D., Lawrenson, J., & Campbell, P. (2024). Barriers and enablers to medication adherence in glaucoma: A systematic review of modifiable factors using the Theoretical Domains Framework. Ophthalmic and Physiological Optics, 44(1), 96–114. https://doi.org/10.1111/opo.13245

Cai, Z., Cao, M., Liu, K., & Duan, X. (2021). Analysis of the responsiveness of latanoprost, travoprost, bimatoprost, and tafluprost in the treatment of OAG/OHT patients. Journal of Ophthalmology, 2021, Article 5586719. https://doi.org/10.1155/2021/5586719

Cordeiro, M. F., Gandolfi, S., Gugleta, K., Normando, E. M., & Oddone, F. (2024). How latanoprost changed glaucoma management. Acta Ophthalmologica, 102(2), e140–e155. https://doi.org/10.1111/aos.15725

Cvenkel, B., & Kolko, M. (2023). Devices and treatments to address low adherence in glaucoma patients: A narrative review. Journal of Clinical Medicine, 12(1), Article 151. https://doi.org/10.3390/jcm12010151

European Glaucoma Society. (2025). European Glaucoma Society—Terminology and guidelines for glaucoma, 6th edition. British Journal of Ophthalmology, 109(Suppl. 1), 1–212. https://doi.org/10.1136/bjophthalmol-2025-egsguidelines

Fahy, E. T., Montesano, G., Garg, A., Vickerstaff, V., Konstantakopoulou, E., & Gazzard, G. (2024). The impact of baseline intraocular pressure on initial treatment response in the LiGHT trial: Selective laser trabeculoplasty versus medication. Ophthalmology, 131(12), 1366–1376. https://doi.org/10.1016/j.ophtha.2024.06.022

Gatwood, J., Brooks, C., Meacham, R., Abou-Rahma, J., Cernasev, A., Brown, E., & Kuchtey, R. W. (2022). Facilitators and barriers to glaucoma medication adherence. Journal of Glaucoma, 31(1), 31–36. https://doi.org/10.1097/IJG.0000000000001965

Hanna, J., Yücel, Y. H., Zhou, X., Kim, N., Irving, H., & Gupta, N. (2021). Beta-adrenergic glaucoma drugs reduce lymphatic clearance from the eye: A sequential photoacoustic imaging study. Experimental Eye Research, 212, Article 108775. https://doi.org/10.1016/j.exer.2021.108775

Harasymowycz, P., Royer, C., Cui, A. X., Barbeau, M., Jobin-Gervais, K., Mathurin, K., Lachaine, J., & Beauchemin, C. (2022). Short-term efficacy of latanoprostene bunod for the treatment of open-angle glaucoma and ocular hypertension: A systematic literature review and a network meta-analysis. British Journal of Ophthalmology, 106(5), 640–647. https://doi.org/10.1136/bjophthalmol-2020-317262

Hsia, Y., Wang, C., Su, C.-C., Huang, J.-Y., Wang, T.-H., & Tu, Y.-K. (2025). Efficacy and drug interactions of glaucoma medications: A systematic review and component network meta-analysis. Ophthalmology, 132(11), 1304–1316. https://doi.org/10.1016/j.ophtha.2025.07.009

Hou, C.-H., & Pu, C. (2024). Long-term effect of systemic comorbidity on glaucoma medication adherence. American Journal of Ophthalmology, 261, 132–140. https://doi.org/10.1016/j.ajo.2024.01.019

Jayaram, H., Kolko, M., Friedman, D. S., & Gazzard, G. (2023). Glaucoma: Now and beyond. The Lancet, 402(10414), 1788–1801. https://doi.org/10.1016/S0140-6736(23)01289-8

Jóhannesson, G., et al. (2024). Guidelines for the management of open-angle glaucoma: National Program Area Eye Diseases, National Working Group Glaucoma. Acta Ophthalmologica, 102(S279), 1–46. https://doi.org/10.1111/aos.16599

Joshi, P., Dangwal, A., Guleria, I., Kothari, S., Singh, P., Kalra, J. M., & Jakhmola, V. (2022). Glaucoma in adults—Diagnosis, management, and prediagnosis to end-stage, categorizing glaucoma’s stages: A review. Journal of Current Glaucoma Practice, 16(3), 170–178. https://doi.org/10.5005/jp-journals-10078-1388

Kang, J. M., & Tanna, A. P. (2021). Glaucoma. Medical Clinics of North America, 105(3), 493–510. https://doi.org/10.1016/j.mcna.2021.01.004

Kim, J.-M., Sung, K.-R., Kim, H.-K., Park, S.-W., Lee, E.-J., Jeoung, J.-W., Park, H.-Y. L., Ahn, J., Yoo, C., & Kim, C.-Y. (2021). Long-term effectiveness and safety of tafluprost, travoprost, and latanoprost in Korean patients with primary open-angle glaucoma or normal-tension glaucoma: A multicenter retrospective cohort study (LOTUS Study). Journal of Clinical Medicine, 10(12), Article 2717. https://doi.org/10.3390/jcm10122717

Kido, A., Miyake, M., Akagi, T., Ikeda, H. O., Kameda, T., Suda, K., Hasegawa, T., Hiragi, S., Yoshida, S., Tsujikawa, A., Tamura, H., & Kawakami, K. (2022). Association between topical β-blocker use and asthma attacks in glaucoma patients with asthma: A cohort study using a claims database. Graefe’s Archive for Clinical and Experimental Ophthalmology, 260(1), 271–280. https://doi.org/10.1007/s00417-021-05357-z

Labay-Tejado, S., Fortuna, V., Ventura-Abreu, N., Hernaez, M., Opazo-Toro, V., Garcia-Humanes, A., Brunet, M., & Milla, E. (2025). Pharmacogenetic influences on individual responses to ocular hypotensive agents in glaucoma patients. Pharmaceutics, 17(3), Article 325. https://doi.org/10.3390/pharmaceutics17030325

Lee, J. S., Park, S., Seong, G. J., Kim, C. Y., Lee, S. Y., Choi, W., & Bae, H. W. (2022). Long-term intraocular pressure fluctuation is a risk factor for visual field progression in advanced glaucoma. Journal of Glaucoma, 31(5), 310–316. https://doi.org/10.1097/IJG.0000000000002011

Maidenko, K. M. (2022). Primary open angle glaucoma: Mechanisms of pathogenesis and genetic predisposition. Medical Science of Ukraine, 18(2), 89–102. https://doi.org/10.32345/2664-4738.2.2022.11

Marko, M., & Pawliczak, R. (2025). An updated insight into the effect of β-adrenergic receptor antagonists (β-blockers) on respiratory function in asthma patients: A systematic review and meta-analysis. Frontiers in Physiology, 16, Article 1582740. https://doi.org/10.3389/fphys.2025.1582740

Mincione, F., Nocentini, A., & Supuran, C. T. (2021). Advances in the discovery of novel agents for the treatment of glaucoma. Expert Opinion on Drug Discovery, 16(10), 1209–1225. https://doi.org/10.1080/17460441.2021.1922384

Moghimi, S., Girkin, C., & Weinreb, R. N. (2025). Intraocular pressure matters. Ophthalmology Glaucoma, 8(5S), S6–S13. https://doi.org/10.1016/j.ogla.2025.07.008

Moore, S. G., Richter, G., & Modjtahedi, B. S. (2023). Factors affecting glaucoma medication adherence and interventions to improve adherence: A narrative review. Ophthalmology and Therapy, 12(6), 2863–2880. https://doi.org/10.1007/s40123-023-00797-8

Oltramari, L., Mansberger, S. L., Souza, J. M. P., de Souza, L. B., de Azevedo, S. F. M., & Abe, R. Y. (2024). The association between glaucoma treatment adherence with disease progression and loss to follow-up. Scientific Reports, 14, Article 2195. https://doi.org/10.1038/s41598-024-52800-2

Patton, G. N., & Lee, H. J. (2024). Chemical insights into topical agents in intraocular pressure management: From glaucoma etiopathology to therapeutic approaches. Pharmaceutics, 16(2), Article 274. https://doi.org/10.3390/pharmaceutics16020274

Purola, P. K. M., Koskinen, S. V. P., & Uusitalo, H. M. T. (2025). First-line glaucoma monotherapy medication patterns in Finland during 1995–2019 based on a population-based study. PLOS ONE, 20(1), Article e0316835. https://doi.org/10.1371/journal.pone.0316835

Reis, T. F., Paula, J. S., & Furtado, J. M. (2022). Primary glaucomas in adults: Epidemiology and public health—A review. Clinical & Experimental Ophthalmology, 50(2), 128–142. https://doi.org/10.1111/ceo.14040

Reitinger, J. C., Reed, D. M., Peres, C., Fan, S., Gulati, V., Kazemi, A., Sit, A. J., Moroi, S. E., & Toris, C. B. (2025). Understanding individual intraocular pressure response to treatment with latanoprost and timolol. Journal of Ocular Pharmacology and Therapeutics, 41(5), 251–258. https://doi.org/10.1089/jop.2024.0112

Quaranta, L., Novella, A., Tettamanti, M., Pasina, L., Weinreb, R. N., & Nobili, A. (2023). Adherence and persistence to medical therapy in glaucoma: An overview. Ophthalmology and Therapy, 12(5), 2227–2240. https://doi.org/10.1007/s40123-023-00730-z

Sakata, R., Chang, P.-Y., Sung, K. R., Kim, T.-W., Wang, T.-H., Perera, S. A., & Cantor, L. B. (2022). Prostaglandin-associated periorbitopathy syndrome (PAPS): Addressing an unmet clinical need. Seminars in Ophthalmology, 37(4), 447–454. https://doi.org/10.1080/08820538.2021.2003824

Shalaby, W. S., Ahmed, O. M., Waisbourd, M., & Katz, L. J. (2022). A review of potential novel glaucoma therapeutic options independent of intraocular pressure. Survey of Ophthalmology, 67(4), 1062–1080. https://doi.org/10.1016/j.survophthal.2021.12.003

Sharif, N. A., Odani-Kawabata, N., Lu, F., & Pinchuk, L. (2023). FP and EP2 prostanoid receptor agonist drugs and aqueous humor outflow devices for treating ocular hypertension and glaucoma. Experimental Eye Research, 229, Article 109415. https://doi.org/10.1016/j.exer.2023.109415

Shen, S. R., Fleming, G. P., Jain, S. G., & Roberts, C. J. (2023). A review of corneal biomechanics and scleral stiffness in topical prostaglandin analog therapy for glaucoma. Current Eye Research, 48(2), 172–181. https://doi.org/10.1080/02713683.2022.2099903

Shu, Y.-H., Wu, J., Luong, T., Mattox, C., Fang, E. N., Lee, B. L., Jones, J. P., Campbell, J., Shih, V., Zhao, C., & Fong, D. S. (2021). Topical medication adherence and visual field progression in open-angle glaucoma: Analysis of a large US health care system. Journal of Glaucoma, 30(12), 1047–1055. https://doi.org/10.1097/IJG.0000000000001943

Skov, A. G., Rives, A. S., Freiberg, J., Virgili, G., Azuara-Blanco, A., & Kolko, M. (2022). Comparative efficacy and safety of preserved versus preservative-free beta-blockers in patients with glaucoma or ocular hypertension: A systematic review. Acta Ophthalmologica, 100(3), 253–261. https://doi.org/10.1111/aos.14926

Subbulakshmi, S., Kavitha, S., & Venkatesh, R. (2023). Prostaglandin analogs in ophthalmology. Indian Journal of Ophthalmology, 71(5), 1768–1776. https://doi.org/10.4103/IJO.IJO_2706_22

Wagner, I. V., Stewart, M. W., & Dorairaj, S. K. (2022). Updates on the diagnosis and management of glaucoma. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 6(6), 618–635. https://doi.org/10.1016/j.mayocpiqo.2022.09.007

Wahyuni, Wibowo, Y. I., & Setiadi, A. A. P. (2023). Effect of education on knowledge, adherence, and intraocular pressure on glaucoma outpatients: A systematic review. The Indonesian Journal of Public Health, 18(1), 142–157. https://doi.org/10.20473/ijph.v18i1.2023.142-157

Winarni, J., Sanjaya, A. P. A., & Khoirudin, M. (2022). The relationship of the level of family knowledge with compliance with medication in glaucoma clients at Poli Rumah Eye Undaan Surabaya. Journal of Scientific Research, Education, and Technology, 1(2), 505–512. https://doi.org/10.58526/jsret.v1i2.269

Wu, S.-N., Huang, C., Wang, Y.-Q., Li, X., Zhang, S.-Q., Chen, X.-D., Qin, D.-Y., Zhu, L., Wen, J.-Y., Luo, N.-C., Hu, J., & Liu, Z. (2024). Adverse events of topical ocular prostaglandin medications for glaucoma treatment: A pharmacovigilance study based on the FAERS database. Therapeutic Advances in Drug Safety, 15, Article 20420986241285929. https://doi.org/10.1177/20420986241285929

Zhou, L., Zhan, W., & Wei, X. (2022). Clinical pharmacology and pharmacogenetics of prostaglandin analogues in glaucoma. Frontiers in Pharmacology, 13, Article 1015338. https://doi.org/10.3389/fphar.2022.1015338