Clinical practices and preferences in glaucoma management in Indian settings: An expert perspective study

Objective: To evaluate clinical practice and preferences among ophthalmologists in India regarding the diagnosis, monitoring, and pharmacological management of glaucoma, with a specific focus on the use of fixed-dose combinations such as brinzolamide and brimonidine.Methodology: In this cross-sectional study, a multiple-response questionnaire was distributed to gather information from clinicians practicing in Indian settings. The 23-item questionnaire assessed prescription patterns, disease characteristics, and treatment preference in glaucoma management. Data were analyzed using descriptive statistics, with categorical variables presented as percentages.Results: The study included 35 clinicians. According to 66% of experts, prostaglandin analogues are the preferred first-line treatment for open-angle glaucoma, while 40% favored beta-blockers as an add-on to monotherapy. Fixed-dose combinations were preferred for dual therapy by 74% of respondents. The brinzolamide + brimonidine combination was favored in 11-25% of glaucoma patients by 63% of experts, with 91% acknowledging its role in enhancing uveoscleral outflow, improving ocular blood flow, and providing neuroprotection. Nearly 46% of clinicians reported that the single bottle eye drops combination lowered intraocular pressure (IOP) by 21-30% from baseline. Approximately 34% preferred alpha-adrenergic agonists as the primary anti-glaucoma medication following Yttrium Aluminum Garnet (YAG) capsulotomy. Furthermore, 40% of clinicians frequently incorporated neuroprotectants in glaucoma management.Conclusion: The study highlights the preference for prostaglandin analogues as first-line therapy and the widespread use of fixed-dose combinations in glaucoma management. Clinicians also recognize the benefits of brinzolamide + brimonidine in improving ocular dynamics and neuroprotection.