A Critical Look: Is Latanoprost the Best Eye Drop for Glaucoma?

October 10, 2025 •

4 min read

Prostaglandin analogs have largely replaced beta-blockers as the most common first-line therapy for glaucoma, with latanoprost as a well-established member of this class. This article examines whether latanoprost is the best eye drop for glaucoma or if newer options might be more effective or better tolerated for certain patients.

Quick Summary

This article examines the efficacy, safety, and tolerability of latanoprost for glaucoma treatment. It compares latanoprost to other leading eye drops, discusses its pros and cons, and explains why the best choice is personalized medicine.

Key Points

First-Line Standard: Latanoprost is a highly effective, once-daily prostaglandin analog and is a primary first-line treatment for glaucoma for many patients.
Balanced Efficacy and Tolerability: Latanoprost offers a favorable balance of strong IOP-lowering efficacy and good tolerability, often causing fewer side effects like conjunctival hyperemia compared to other prostaglandin analogs.
Efficacy Similar to Competing PGAs: Its overall IOP-lowering effect is comparable to other prostaglandin analogs like bimatoprost and travoprost, although subtle differences may exist.
Key Adverse Effects: Common side effects include potentially permanent iris and eyelid pigmentation, as well as longer and thicker eyelashes.
Newer Options with Different Mechanisms: Newer medications like latanoprostene bunod (Vyzulta) or fixed combinations with netarsudil (Rocklatan) may offer even greater IOP reduction through dual mechanisms of action.
The 'Best' Is Individualized: The most suitable eye drop depends on the patient's specific needs, side effect tolerance, target IOP, and cost, requiring a tailored approach from an eye care specialist.

Latanoprost's Place in Glaucoma Treatment

Glaucoma is a group of eye conditions that damage the optic nerve, often caused by abnormally high pressure in the eye (intraocular pressure or IOP). If left untreated, this can lead to vision loss and blindness. The primary goal of medical treatment is to lower IOP to a safe level to prevent or slow down optic nerve damage. Medication, typically in the form of eye drops, is the most common starting point for therapy.

Latanoprost (brand name Xalatan) was the first prostaglandin analog (PGA) approved for glaucoma and quickly became a standard first-line treatment. It works by increasing the outflow of aqueous humor from the eye through the uveoscleral pathway, effectively lowering IOP. Its appeal lies in its once-daily dosing and strong efficacy.

Latanoprost vs. Other Medication Classes

When it comes to lowering IOP, prostaglandins like latanoprost are generally more effective than older classes of glaucoma medication, such as beta-blockers, carbonic anhydrase inhibitors, and alpha-adrenergic agonists. For example:

Beta-Blockers (e.g., Timolol): Meta-analyses have shown latanoprost provides a greater IOP reduction than timolol. While timolol is effective, it has more systemic side effects, particularly for patients with heart or lung conditions.
Carbonic Anhydrase Inhibitors (CAIs) (e.g., Dorzolamide): Latanoprost has been shown to be significantly more effective than dorzolamide in reducing mean IOP.
Alpha-Adrenergic Agonists (e.g., Brimonidine): Similarly, latanoprost has a confirmed superior IOP-lowering effect compared to brimonidine.

Latanoprost vs. Other Prostaglandin Analogs (PGAs)

Latanoprost faces its closest competition from other PGAs. While all PGAs share a similar mechanism, small differences in their chemical structure can lead to variations in efficacy and side effects.

Bimatoprost (Lumigan)

Efficacy: Some studies have shown bimatoprost to provide a slightly greater IOP reduction than latanoprost, especially for achieving very low target pressures, but this difference is not consistent across all trials.
Tolerability: Bimatoprost is associated with a significantly higher incidence of conjunctival hyperemia (eye redness), eyelash changes, and periorbital pigmentation than latanoprost.

Travoprost (Travatan Z)

Efficacy: Comparative studies and meta-analyses generally find no clinically significant difference in efficacy between latanoprost and travoprost. One study noted that travoprost might offer a slightly greater hypotensive effect in the late afternoon.
Tolerability: Travoprost is associated with a higher incidence of conjunctival hyperemia than latanoprost.

Newer Glaucoma Medications

The landscape of glaucoma treatment continues to evolve with newer drug options providing novel mechanisms or improved formulations.

Latanoprostene Bunod (Vyzulta): A newer medication that is a nitric oxide-donating prodrug of latanoprost. It provides a dual mechanism of action by increasing outflow through both the uveoscleral and trabecular meshwork pathways. Studies show it can produce a greater IOP reduction than latanoprost and timolol.
Netarsudil (Rhopressa): A rho kinase inhibitor that increases aqueous humor outflow through the trabecular meshwork. It is available as a combination eye drop with latanoprost (Rocklatan), which offers a dual mechanism of action for enhanced pressure reduction.
Preservative-Free Formulations: Many standard eye drops contain preservatives like benzalkonium chloride (BAK), which can cause ocular surface irritation and damage. Preservative-free formulations of latanoprost (e.g., Iyuzeh, Xelpros) and tafluprost (Zioptan) can improve tolerability for sensitive patients.
Sustained-Release Implants: For patients with poor adherence to daily eye drops, options like the Durysta implant (bimatoprost) can provide sustained IOP control for several months.

Comparison of Latanoprost with Other First-Line Treatments


Feature	Latanoprost (Generic)	Bimatoprost (Lumigan, Generic)	Travoprost (Travatan Z, Generic)	Latanoprostene Bunod (Vyzulta)
Drug Class	Prostaglandin Analog	Prostaglandin Analog	Prostaglandin Analog	Nitric Oxide-Donating Prostaglandin Analog
Mechanism	Increases uveoscleral outflow	Increases uveoscleral and trabecular outflow	Increases uveoscleral outflow	Increases both uveoscleral and trabecular outflow
Efficacy	Strong; standard first-line therapy	Some studies show slightly greater IOP lowering	Generally comparable to latanoprost	In studies, has shown greater IOP reduction
Common Side Effects	Iris and eyelid pigmentation, eyelash growth, hyperemia	More frequent and intense hyperemia and eyelash changes than latanoprost	More frequent hyperemia than latanoprost	Similar side effects, but potentially more hyperemia
Tolerability	Generally well-tolerated, less redness than other PGAs	Less tolerated due to higher redness incidence	Less tolerated due to higher redness incidence	Manageable adverse events; further research needed
Dosing	Once daily, evening	Once daily, evening	Once daily, evening	Once daily, evening
Cost	Typically low-cost (generic availability)	Often higher cost than generic latanoprost	Often higher cost than generic latanoprost	Brand-name, newer, likely higher cost

Is Latanoprost the 'Best'? A Conclusion

While latanoprost is not universally the "best" eye drop for glaucoma, it remains an excellent and highly effective standard of care. Its proven efficacy, convenient once-daily dosing, and generally favorable tolerability profile make it a strong candidate for first-line therapy in many patients.

However, the concept of the "best" eye drop is subjective and highly dependent on individual factors, which is why consultation with a healthcare provider is critical. For some patients, the potential for slightly greater IOP reduction offered by bimatoprost or latanoprostene bunod might be worth the increased risk of side effects. For those with ocular surface disease or sensitivity to preservatives, a preservative-free latanoprost formulation could be the superior choice. In cases of poor adherence, a sustained-release implant might be a game-changer. Ultimately, the ideal treatment regimen is a personalized decision made in partnership with an eye care specialist, considering the patient's target IOP, side effect tolerance, and lifestyle needs.

For a comprehensive overview of various eye drop options, consult the Glaucoma Research Foundation.

Frequently Asked Questions

Latanoprost works by increasing the outflow of aqueous humor, the fluid inside the eye, primarily through the uveoscleral pathway, which reduces intraocular pressure.

For most patients, latanoprost is administered as one drop, once daily, typically in the evening to maximize its IOP-lowering effect.

Yes, a key side effect of latanoprost is the potential for increased brown pigmentation in the iris, which can be permanent, especially in individuals with mixed-color eyes (blue-brown, green-brown, etc.).

Studies show that latanoprost is generally more effective at lowering intraocular pressure than timolol, an older class of medication. Latanoprost also has minimal systemic side effects.

Yes, preservative-free formulations of latanoprost are available and may be a better option for patients who experience irritation or discomfort from the preservative benzalkonium chloride (BAK) found in standard drops.

While some studies suggest bimatoprost may offer slightly greater IOP reduction than latanoprost, it is also associated with more frequent side effects like conjunctival hyperemia and eyelash growth.

Newer medications include latanoprostene bunod (Vyzulta), a nitric oxide-donating prostaglandin analog, and rho kinase inhibitors like netarsudil (Rhopressa), which offer different mechanisms for lowering eye pressure.