AAOpt 2026: The underutilization of latanoprostene bunod 0.024% in glaucoma care

Among his several presentations and happenings at AAOpt 2026 in Anaheim, California, Christopher W. Lievens, OD, MS, PhD, FAAO, FNAP, FBCLA, spoke on a poster abstract examining real-world use of latanoprostene bunod 0.024% (Vyzulta, Bausch + Lomb) in glaucoma and ocular hypertension care. The poster, titled “Latanoprostene bunod 0.024% Initiation in Medicare Fee-for-Service Patients with Open Angle Glaucoma and Ocular Hypertension,” was presented during the conference.

The retrospective observational study utilized linked Medicare fee-for-service Parts A, B, and D claims and IRIS® Registry data and demonstrated a possibility for latanoprostene bunod to be used earlier in the treatment of patients with open-angle glaucoma (OAG) or ocular hypertension (OHT).

The drug and why it's different

Lievens opens by explaining that latanoprostene bunod is a relatively new entrant among early pharmacologic glaucoma treatments and is unique as the only prostaglandin analog with a nitric oxide component. It does what other prostaglandin analogs do by increasing uveoscleral outflow, but the nitric oxide portion additionally increases outflow through the trabecular meshwork — a dual mechanism that gives it a mechanistic advantage over others in its class.

Study design and findings

Because insurance coverage has improved substantially since launch, the research team asked why the drug still isn't a first choice. The research team analyzed open-access Medicare data across a 2-year span, January 1, 2021 through December 31, 2023, identifying beneficiaries diagnosed with and treated for OAG or OHT, and cross-checking intraocular pressure (IOP) measurements for consistency with those diagnoses. Of thousands of patients, just under 1000 received latanoprostene bunod. Demographically, they were nearly 75% Caucasian, roughly 50-50 male/female with slightly more women, and older, with a mean age just over 80. Notation suggested moderate-to-severe disease, implying latanoprostene bunod was often a pivot after another drug underperformed rather than a first agent.

Nothing surprising, but a clear barrier

When questioned about surprises in study findings, Lievens said there weren’t any — newer drugs carry higher costs and copays, and tier affordability drives prescribing habits, including their own. Time has now passed and coverage is good, so this may be the moment to change behavior.

Clinical application

Reviewing the pivotal FDA trial data, Lievens concluded latanoprostene bunod is not merely non-inferior but superior to latanoprost (originally Xalatan), and personally switched to prescribing it for new primary OAG and ocular hypertensive patients — a recommendation he says is independent of age and applies to any adult, not just older patients. He agrees that latanoprostene bunod is underutilized as an early option and call for renewed manufacturer messaging, with this abstract as a jumping-off point.

Future research

Efficacy and the minor side-effect profile are already established. More intriguing was a subset treated at a pre-treatment IOP of 19 — below the typical 22-and-above range — hinting that normal-tension glaucoma patients may also be well suited to the product. With the study infrastructure now built, Lievens proposes rerunning the analysis for 2023–2025 to plot utilization over time and present next year.

Clinical pearl

According to Lievens, latanoprostene bunod 0.024% is not an "also-ran" in a first-line class — it outperforms its peers, and with insurance no longer a barrier there is a strong argument it should be the number one first pharmaceutical choice at diagnosis.