Systematic reviews «Boland MV, Ervin AM, Friedman DS ym. Comparative e...»1 comparing timolol with travoprost and latanoprost showed prostaglandin analogues to be more effective at decreasing IOP. Two systematic reviews concluded that bimatoprost 0.03 % decreased IOP more effectively than did latanoprost at 3 months (risk difference [RD], 12 [95 % CI, 4 to 21]), although this difference was not present at 1 and 6 months. Two reviews concluded that mean IOP reduction was similar with travoprost and latanoprost. For the comparison of bimatoprost with travoprost, one review reported a significant difference in favor of bimatoprost at 3 or more months of follow-up (weighted mean difference, 0.88 [CI, 0.13 to 1.63]), whereas another review concluded that bimatoprost and travoprost were similarly effective (weighted mean difference, 0.08 [CI 0.62 to 0.79]).
All but 3 of the studies assessing medical treatments for decreasing IOP were included in systematic reviews. Two studies examined brand and generic latanoprost and found that both decreased IOP equivalently, by 6 to 7 mm Hg. A single study also showed that latanoprost (7.5 mm Hg) and the combination of brimonidine–timolol (7.0 mm Hg) both decreased IOP by the same amount.
The strength of evidence from these 3 most recent trials was judged to be low. However, with the addition of the consistent high-quality systematic reviews, the conclusion that topical glaucoma medications decrease IOP is wellsupported, as is the conclusion that prostaglandin agents are superior to other monotherapies with regard to decreasing IOP.