Attitudes pratiques

Even if glaucoma treatment often begins with monotherapy, combined treatments are in fact frequent. However, they are associated with poorer compliance, which may lead to lower efficacy, notably if the delay between two eyedrops is too short. The main advantages of fixed combinations are better therapeutic compliance and a lesser effect of dilution of the first eyedrops by the second. Nevertheless, it is impossible to change the dosing interval of one or the other of the components and adverse side effects cannot be controlled. The fixed combinations available today or in the near future are based for the most part on the combination of timolol and a prostaglandin. Their efficacy is comparable to the efficacy of each of the components or of nonfixed combinations, but it is not strictly equivalent. This difference (on the order of 1 mmHg) could be explained by unsuitable frequency or poor timing of the instillation.