Switching Glaucoma Drops: What 833 Patients in a National Registry Showed After a Change to Latanoprostene Bunod

Many people with glaucoma are told their eye pressure “looks fine,” yet tests show the disease is still progressing. When that happens, doctors often change medication. At the American Academy of Optometry meeting in 2026, Nora Lee Cothran, OD, presented a real-world study of what happened when patients were switched to latanoprostene bunod (Vyzulta), a once-daily drop.

What the study looked at

The researchers used the American Academy of Ophthalmology’s IRIS Registry, a national database of eye care records. They found 833 patients with open-angle glaucoma or high eye pressure who were switched to latanoprostene bunod because their disease was progressing on a previous treatment. Unlike clinical trials, these patients did not stop their old drop and wait before switching; their doctors changed treatment right away, as happens in everyday practice.

What they found

• Pressure dropped further in all severity groups: about 2.8 mmHg in mild, 2.7 mmHg in moderate and 2.4 mmHg in severe glaucoma.
• Nearly half of the patients (47.9%) had starting pressures below 18 mmHg but were still progressing. They also got additional lowering.
• The largest drop, 5.9 mmHg, was in patients whose starting pressure was above 21 mmHg.

Dr. Cothran said the value is extra pressure lowering without adding another bottle. Registry studies cannot prove cause and effect as well as randomized trials, and the presentation did not report long-term field outcomes.

What this means for you

• “Normal” pressure is not the goal by itself. Your target depends on your nerve and visual field tests.
• If your glaucoma is progressing, ask whether a medication switch, laser or a procedure is the right next step.
• Bring all your drops to visits, and mention redness, eyelash changes or other side effects.
• Use drops at the same time each day and close your eyes for a minute afterward to help absorption.

Long-term drop use can irritate the eyelids and eye surface; this eyelid and dry eye blog explains why.

I remind my glaucoma patients that progression, not just the pressure number, guides our decisions. Fewer bottles with better control is always a good goal.

Source: AAOpt 2026: The real-world impact of treatment switch to latanoprostene bunod (Optometry Times, 10/2026). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.