Question of the Week

Correct Answer: D) Bimatoprost

This patient most likely has open-angle glaucoma in the setting of T2DM due to the increased tonometry and classical finding of increased cup-disc ratio. Although this patient has no complaints of peripheral vision loss, the early stages of open-angle glaucoma can lead to slow, progressive peripheral vision loss that may go unnoticed. Topical prostaglandins (bimatoprost, travoprost) are chosen as initial monotherapy for open-angle glaucoma due to consistency demonstrating reduction in IOP with no risk of systemic side effects. First line therapy is often pharmacotherapy but Selective Laser Trabeculoplasty (SLT) is also offered to patients who do not want to do medications or are younger who require more long term treatment. The LiGHT trial demonstrated SLT as an equivalent first line option alongside prostaglandin eye drops. There are also many combinations of these therapies for patients such as dorzolamide-timolol, but often are not used as initial treatment. Once any visual field has been lost, that portion can not be recovered. 

A) Beta blockers are often used to treat open-angle glaucoma and have been shown to decrease IOP after just a few months of use. However, prostaglandins are considered first line due to low risk of systemic effects. Beta blockers can also mask symptoms of hypoglycemia (tremors, tachycardia) in patients with diabetes.

B) Anti-VEGF are used often to treat proliferative diabetic retinopathy or diabetic macular edema to reduce swelling and slow growth of abnormal blood vessels.

C) Steroids can also be used in proliferative diabetic retinopathy or diabetic macular edema to reduce swelling.

E) Alpha adrenergic agonists can also potentially be chosen for open-angle glaucoma to lower IOP but are associated with many side effects such as allergic conjunctivitis, hyperemia, and ocular pruritus.

Jacobs, D. S., & Lin, M. (2026, July 17). Open-angle glaucoma: Treatment. UpToDate. https://www.uptodate.com/contents/open-angle-glaucoma-treatment

Open-angle glaucoma. Open-angle glaucoma - Symptoms, diagnosis and treatment | BMJ Best Practice US. (2025, June 12). https://bestpractice.bmj.com/topics/en-us/373