AAOpt 2026: The real-world impact of treatment switch to latanoprostene bunod

Nora Lee Catherine, a consultative optometrist at the Eye Institute of West Florida, presented a poster on a real-world study of latanoprostene bunod (LBN) and its effect on intraocular pressure (IOP) in patients with glaucoma, titled “Real-World Impact of Treatment Switch to Latanoprostene Bunod on Intraocular Pressure in Glaucoma Patients: An Academy IRIS® Registry study.” The study used data from 833 patients in the Academy IRIS Registry who had been switched to LBN because their glaucoma was progressing on a prior treatment. Cothran explains that clinical trials often take place under more controlled conditions, including medication washout, whereas real-world clinicians may switch a patient’s treatment immediately when progression is observed.

The study examined whether LBN’s IOP-lowering effect differed by glaucoma severity. Patients were grouped as having mild, moderate, or severe disease. The reported results showed additional IOP reductions across all three groups, with reductions of approximately 2.4 mmHg in severe, 2.7 mmHg in moderate, and 2.8 mmHg in mild glaucoma. Cothran’s main takeaway is that the medication appeared to provide additional pressure lowering across disease-severity categories.

The researchers also grouped patients by their starting IOP while they were already receiving treatment: above 21 mmHg, 19–20 mmHg, or 18 mmHg and below. Nearly half of the patients switched to LBN—47.9%—had starting pressures below 18 mmHg but were still experiencing disease progression. Patients in all starting-pressure groups achieved further IOP reductions after switching. The largest reported reduction was among those whose starting IOP was above 21 mmHg: 5.9 mmHg of additional lowering.

Catherine emphasizes the potential clinical value of lowering pressure further without adding treatment burden, particularly for patients who are progressing despite pressures that may seem controlled. She suggests that additional pressure reduction may help mitigate disease progression and potentially preserve patients’ quality of life.

Looking ahead, Cothran advocates for research into the mechanisms behind these treatments, especially how individual molecules behave in the anterior chamber and affect aqueous humor dynamics. She identifies the trabecular meshwork—the primary site of outflow dysfunction in glaucoma—as an important area for future investigation, with possible relevance to both topical therapies and surgical treatments. Cothran closes by thanking her collaborators and encouraging colleagues to investigate clinically meaningful questions, noting that real-world data can continue to yield useful findings even for medications already available commercially.