Which drug is listed as a second-line treatment for NTG?

• A. Latanoprostene bunod 0.024% qhs
• B. Brimonidine 0.2% bid
• C. Betaxolol 0.25-0.5% bid
• D. Dorzolamide 2% bid

Answer: (A)

In NTG, the aim is to lower the eye pressure enough to slow optic nerve damage, often by stepping up therapy if a single agent isn’t enough. Latanoprostene bunod fits as a second-line option because it combines a prostaglandin effect with a nitric oxide donor. This dual action enhances aqueous humor outflow through both the trabecular (conventional) pathway and the uveoscleral pathway, producing greater IOP reduction than a prostaglandin alone. It’s especially useful when additional lowering is needed beyond a first-line agent or when switching to a different mechanism is preferred. The other drugs listed—brimonidine, betaxolol, and dorzolamide—are commonly used as adjuncts or as alternatives with more limited suitability as a primary second-line choice in this specific scenario due to their systemic or local side effects and the desire for a dual-mechanism, once-daily option.