In my 25 years specializing in glaucoma, our therapy has never been described as aesthetic—tolerable maybe. The preservation of vision by lowering pressure has been our motto. The side effects of our treatments were a small price to pay. A little conjunctival redness, ocular irritation, or deposition of pigment was tempered by the extent to which the IOP decreased: whatever it takes to keep the IOP under control. The glaucoma community in general has avoided the move to aesthetic medicine. While we have been worrying about visual field loss and optic nerve cupping, many of our colleagues have been shifting gears to offer cosmetic (cash only) medical procedures in the areas of refractive and plastic surgery.
Little did most of us realize that right under our noses (or, in this case, to the left and right of our patients' noses) was the opportunity to join the "cosmetic" party. To my knowledge, Murray Johnstone, MD, was the first to observe and report on the growth of eyelashes with the topical use of latanoprost.1 Although we thought that the prostaglandin analogues were effective therapy for glaucoma, few of us realized their potential commercial value in the growth of hair.
By now, readers are aware that Allergan, Inc. (Irvine, CA), received FDA approval for Latisse Eyelash Treatment. Users will administer Latisse (bimatoprost ophthalmic solution 0.03%, the same concentration as the company's Lumigan drops) once daily with a lash applicator wand. Whether bimatoprost works by increasing blood flow in the lid margin or some other mechanism, the use of the prostaglandin analogues for growing hair is in high gear.
What can we expect? Certainly, the other side effects of bimatoprost (ie, hyperemia, ocular irritation, pigmentation of the skin of the lower eyelid and iris, etc.) are still a concern. Will our glaucoma patients be inclined to be more compliant with prescribed therapy now that this cosmetic benefit has been publicized? That is doubtful. As the marketing and advertising campaigns for cosmetic prostaglandins ramp up, however, interest in and awareness of glaucoma and the medications involved in its management may increase.
What are the early lessons of Latisse? First, if we pay attention to our patients, we may find a treatment or side effect with unexpected benefits. Second, we should relish the opportunity to offer an effective and proven therapy for glaucoma that also has desirable side effects. Finally, let's work to make other glaucoma therapies—especially the surgical approaches—as aesthetic as they are effective.
