Clinicians’ perspectives on the use of triple fixed-dose combination timolol + brinzolamide + brimonidine in glaucoma management in Indian settings

Objectives: To assess the clinicians’ perspectives and preferences on the current glaucoma management among Indian clinicians, focusing on the triple fixed-dose combination (FDC) timolol + brinzolamide + brimonidine. Material and Methods: This cross-sectional study utilized a multiple-response questionnaire to survey 129 Indian clinicians between June 2023 and December 2023. Participants provided written informed consent and completed the survey independently. The study questionnaire comprised 23 questions regarding clinical practice patterns, disease characteristics, treatment outcomes, and experiences with triple FDC therapy. The data were analyzed using descriptive statistics. Results: The majority of clinicians (89.15%) recognized the therapeutic benefits of the FDC including reduced aqueous humor production, improved ocular blood flow, and neuroprotection. A significant proportion of them (30.23%) reported an intraocular pressure (IOP) reduction of 21–30%, while 29% noted fewer daily drops and preservatives, and 16% observed better compliance. More than half of the participants (59.69%) were satisfied with the additional IOP reduction after switching from a dual-drug FDC. Tolerability was rated very good (53.49%) or excellent (33.33%). Reduced preservative exposure was linked to lower ocular surface damage (34.11%) and improved compliance (31%). Most clinicians recommended timolol + brinzolamide + brimonidine for patients requiring more than three drugs, those on prostaglandin analog (PGA) or dual therapy without target IOP control, PGA monotherapy requiring further reduction, and comprehensive IOP management. Conclusion: While early clinical experience with this triple FDC of timolol + brinzolamide + brimonidine appears promising in terms of efficacy, tolerability, and practical benefits, long-term studies with larger patient populations are needed to fully establish its place in the glaucoma treatment paradigm.