We read with great interest the article by Sherwood and colleagues1 describing the 12-month trial of twice-daily fixed-combination 0.2% brimonidine–0.5% timolol vs monotherapy with the individual components. The authors observed that the rate of allergic conjunctivitis in patients who received the combination product (5.2%) was significantly lower than that seen in patients who received brimonidine alone (9.4%). The authors acknowledge that a partial explanation for the improved tolerability may be related to the fact that the combination product is dosed twice daily while brimonidine was dosed 3 times daily. We would like to postulate that the lower rate of ocular allergy observed in their study may be a direct result of the addition of timolol to brimonidine based on a concept originally described by us a decade ago.2
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