20 months ago

anonymous FitEyes member ♦ 1.1k

@member_31

Which prostaglandin-class glaucoma eye drops have worked best for you?

I am using Latanaprost by Bauch and Lomb. What are your thoughts on that particular one? Have you found one that works better for you?

20 months ago

david 4.3k

@david_fe

In my personal experiments, here's how I rank the prostaglandins:

1. bimatoprost 0.03% (Lumigan®, Allergan, Inc.). This is the original Lumigan formula with less BAK. This gave me the lowest IOP of the prostaglandins I tested.

2. tafluprost 0.0015% (Zioptan®, Akorn). This is my preferred prostaglandin at the moment because it lowers my IOP very well and is 100% preservative-free.

3. latanoprost 0.005% (Xalatan®, Pfizer, Inc.). The efficacy is similar to Zioptan for me, but Xalatan contains BAK so I do not use it.

4. travoprost as Travatan-Z. This drop irritates my eyes quite a bit and it doesn't lower my IOP nearly as well as the prostaglandins mentioned above.

5. travoprost 0.004% (Travatan®, Alcon Laboratories, Inc.). This irritates my eyes even more and has the same reduced efficacy as Travatan-Z.

In addition to the drops I used in those experiments above, there are several newer options available now.

1. latanoprost 0.005% (XELPROS®, Sun Ophthalmics). It has the same potency as Xalatan, but it uses a novel LIPIXELLE® technology to avoid using BAK. It also does not require refrigeration, unlike many others mentioned here.

2. latanoprost 50 μg/mL (Monoprost®). A preservative-free (PF) formulation of latanoprost approved in the EU and other countries, but not currently approved in the USA.

Note on Lumigan versions:

The original Lumigan was the 0.03% version.

• Lumigan 0.01% contains 0.2 mg/mL benzalkonium chloride ("BAK").
• Lumigan 0.03% contains only 0.05 mg/mL benzalkonium chloride.

Lumigan 0.01% contains 400% more BAK and is approximately 0.5 mmHg less effective than Lumigan 0.03% (according to the company's own data). I have not tried the 0.01% version. Last time I checked, I was not able to get the 0.03% version, and since then I have been using Zioptan.

Note on other options not mentioned here:

There are also some combination options available where a prostaglandin is combined with another active ingredient. I limited my reply to single-active ingredient prostaglandins because you mentioned latanoprost specifically.

20 months ago

david 4.3k

@david_fe

Another option is Vyzulta, which consists of latanoprost and a NO (nitric oxide) donor. Vyzulta has helped some patients reduce their IOP even further beyond just what latanoprost (or the other prostaglandins alone) can achieve. However, Vyzulta it has not been as effective for everyone. Since we all respond differently, your mileage may vary. Hopefully, it works for you.

In my case, Vyzulta is even more effective than any of the single-active-ingredient prostaglandins mentioned in my other answer here. I did not mention it in that answer because Vyzulta is not a pure prostaglandin drop.

As for a preservative-free version of Vyzulta, none exists and the patent has not expired yet so don't hold your breath.

Anyways, Vyzulta is a good option for many people, including me. However, it's very expensive and not always covered by insurance.

A FitEyes member reports that his insurance (Anthem Blue Cross) does not cover it, unfortunately.

One can also buy it from reputable Canadian on-line pharmacies (we have discussed this before on FitEyes) for a fraction of the price offered in the US and in some cases cheaper than with insurance coverage. One can also go the route of manufacturer coupons if you are not on Medicare and you qualify.

Thanks to Amin for all this information (via the FitEyes email discussion).