Challenging the "Topical Medications-First” Approach to Glaucoma: A Treatment Paradigm in Evolution

Nathan M. Radcliffe, Manjool Shah, Thomas W. Samuelson

Research output: Contribution to journalComment/debate

1 Scopus citations


Topical glaucoma medications are effective and safe, but they have numerous well-documented limitations that diminish their long-term utility and sustainability. These limitations can include high rates of nonadherence (with associated glaucoma progression), concerning side effects, inconsistent circadian intraocular pressure (IOP) control, complex dosing regimens, difficulty with self-administration, costs, and decreased quality of life. Despite these limitations, topical medications traditionally have been first-line in the glaucoma treatment algorithm, as no other minimally invasive treatment alternatives existed. In recent years, however, novel interventional therapies—including sustained-release drug-delivery platforms, selective laser trabeculoplasty, and micro-invasive glaucoma surgery procedures—have made it possible to intervene earlier without relying on topical medications. As a result, the topical medication-first treatment approach is being reevaluated in an overall shift toward earlier more proactive interventions.

Original languageEnglish
Pages (from-to)2823-2839
Number of pages17
JournalOphthalmology and Therapy
Issue number6
StatePublished - Dec 2023
Externally publishedYes


  • Early
  • Intervention
  • MIGS/micro-invasive glaucoma surgery
  • Medication
  • SLT/selective laser trabeculoplasty
  • SRDD/sustained release drug delivery
  • Treatment


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