One of the most important conversations you’ll have with your ophthalmologist early on is about how to begin managing your intraocular, or internal eye, pressure (IOP)—the main risk factor for glaucoma progression. There’s no single “best” first-line treatment for everyone. Your doctor will recommend options based on your specific type of glaucoma, as well as your overall health, lifestyle, and comfort with different treatments. Here are some of the most commonly recommended first-line therapies to help you prepare for that conversation.*.

Eye Drops: Still the Most Common Starting Point

For decades, eye drops—especially a class called prostaglandin analogs (PGAs)—have been the standard first treatment for glaucoma. These medications, like latanoprost and bimatoprost, work by helping fluid drain out of your eye more efficiently, which lowers IOP.

Many ophthalmologists start here because these drops are both effective and convenient. Side effects are usually mild and limited to the eye, such as redness or changes in iris color. Over time, you may notice your eyelashes growing longer—something some patients welcome, while others do not.

The challenge for many patients is consistency. Forgetting doses can compromise long-term outcomes, and it may take several weeks for the drops to reach full effect. Still, if you’re comfortable using drops daily and don’t have sensitivities, this is often the first tool your doctor will reach for.

Laser Treatment

If you’re not keen on starting a lifelong daily medication or you worry you might forget to take your drops regularly, selective laser trabeculoplasty (SLT) may be an alternative. SLT is a quick, outpatient laser procedure that helps your eye drain fluid more effectively.

It doesn’t require any incisions or anesthesia, and research—including the 2019 LiGHT study—has shown that SLT can be just as effective as eye drops in lowering pressure, especially in the early stages of glaucoma. Best of all, the effects can last years, and the procedure can be repeated if needed.

SLT isn’t perfect—it doesn’t work for everyone, and its effectiveness can wane over time—but for patients who want to avoid the daily hassle of drops or have trouble affording medications, it offers a potential alternative.

Beta-Blockers

Another class of eye drops often used alone or alongside PGAs is beta-blockers, such as timolol. These reduce fluid production in the eye and have a rapid onset of action. Unlike PGAs, however, beta-blockers can be absorbed systemically and may affect your heart and lungs, especially if you have:

• Asthma,  
• COPD, or 
• Heart rhythm issues.

Because of these risks, beta-blockers are usually reserved for patients who can’t tolerate other medications or who need additional pressure reduction beyond what PGAs or SLT can offer. They may also be a more cost-effective option in some cases, though the potential side effects make careful screening essential.

Choosing What’s Right for You

Every glaucoma journey is unique. While one person might feel confident starting with a once-daily drop, another may prefer the simplicity of a laser procedure. Some may need a combination of both. The key is working with your ophthalmologist to consider not just what works clinically, but also what fits into your life.

Ask questions, voice any concerns, and remember that the goal of treatment is to protect your vision, not just today, but for decades to come.

To ensure that we always provide you with high-quality, reliable information, Responsum Health closely vets all sources. We do not, however, endorse or recommend any specific providers, treatments, or products, and the use of a given source does not imply an endorsement of any provider, treatment, medication, procedure, or device discussed within.