Kusuhara S, et al. - Given that ripasudil hydrochloride hydrate (brand name: Glanatec ophthalmic solution 0.4%; Kowa Company, Ltd., Japan) is a Rho-associated coiled-coil-containing protein kinase inhibitor that lowers intraocular pressure (IOP) by increasing conventional aqueous outflow, researchers tested the effectiveness and safety of ripasudil and discussed the selection of patients to maximize the benefits of this newly developed glaucoma eyedrop. The authors concluded that ripasudil is well tolerated and effective against almost all glaucoma subtypes. As far as safety is concerned, conjunctival hyperemia is the most common adverse drug reaction (ADR), but it is unlikely to be a reason for discontinuation if the patient is pre-informed, as it is usually transient and mild. On the other hand, blepharitis and allergic conjunctivitis are ADRs that need to be carefully monitored as they may cause ripasudil discontinuation. In terms of efficacy, it is predicted that ripasudil would lower IOP in almost all glaucoma subtypes, regardless of the pattern of initiation of the procedure.