World Glaucoma Week: A retina specialist's guide to recent innovations in glaucoma

During the week of March 6-12, 2022, the globe celebrates World Glaucoma Week. Ophthalmologists and researchers have made great strides in the management of this disease. From implants and robotics to proper administration of eye drops, glaucoma is treated more effectively than ever.

Despite great strides in management, scientists continue to innovate. Here are some of the latest discoveries in glaucoma.

Glaucoma News

Study: Minorities with glaucoma facing cost barriers to medication

A study of 3826 patients with glaucoma has found significantly higher odds of self-reported difficulty affording medication observed among non-Hispanic African American and Hispanic individuals compared with non-Hispanic White individuals.

Study examines data on drug metabolism and distribution in the eye

Both industry and academia are highly interested to advance ocular drug discovery and development.

Ocular pharmacokinetics is a key science in this process, and knowledge of drug metabolism and distribution in the eye is required. However, information on drug-metabolizing enzymes is only sparsely available and new insights in this field will benefit the current and future development of ocular therapies.

Researchers from the School of Pharmacy at the University of Eastern Finland in collaboration with Boehringer Ingelheim have recently published one of the most comprehensive ocular pharmacokinetic studies that investigated the metabolism of four drugs in the rabbit eye (acetaminophen, brimonidine, cefuroxime axetil, sunitinib).

Science fiction or science fact in eye care

Ranya Habash, MD, medical director of Technology Innovation, assistant professor of Clinical Ophthalmology at Bascom Palmer Eye Institute, University of Miami in Miami, Florida, offers a preview of her New Horizons keynote speech on "The future of eye care: science fiction to science fact."

Novel devices, drugs driving expansion in glaucoma market

The glaucoma market seems to be in an expansion phase as evidenced by the explosions in the numbers of new pharmaceutical and surgical options entering the marketplace. The introduction of new devices is possibly the single most influential factor currently driving the glaucoma market.

“The introduction of the microinvasive surgical devices [MIGS] especially has resulted in the opening up of the market to a new group of surgeons, with the cataract surgeons now performing combination procedures. The interest in MIGS has been increasing since this development,” according to Kristen Ingenito, MBA, who spoke at the Glaucoma 360 New Horizons Forum.

She continued, “The introduction of new devices is resulting in increases in both the numbers of doctors performing glaucoma procedures and in the numbers of patients that benefits from the procedures.”

Implants

POAG ocular implant met primary, secondary endpoints in Phase 2a study

PolyActiva Pty Ltd. announced that the Phase 2a study of its PA5108 ocular implant for the treatment of primary open-angle glaucoma (POAG) met both the study's primary and secondary efficacy endpoints of at least 20% IOP lowering in its low dose cohort.

Bimatoprost implant successfully lowers IOP in Phase 3 of the ARTEMIS study

At the 2021 American Academy of Ophthalmology (AAO) meeting, Dr Felipe Medeiros of the Duke Eye Centre presented data on Durysta. Dr Michael R. Robinson, Vice President and Global Therapeutic Area Head of AbbVie, sits down to discuss these results.

Genetics & Gene Therapy

Identifying individuals at risk of glaucoma via genetics studies

Genetic investigations have garnered a wealth of information about glaucoma. The findings have pinpointed specific genes involved in early-onset familial disease with autosomal dominant or recessive inheritance, as well as genetic risk factors for common glaucoma types with complex inheritance patterns.

Dr Janey Wiggs, the Paul Austin Chandler Professor of Ophthalmology, Harvard Medical School, Massachusetts, United States, defined the major goals of genetic research as being to identify at-risk individuals and to use knowledge about disease-causing genes to develop novel therapies.

African American glaucoma study targets gene therapy options

The Primary Open-Angle African American Glaucoma Genetics (POAAGG)study has a population-based, cross-sectional, case-control design and focuses on investigating POAG for clues in the patients’ DNA that might help predict their risk of developing glaucoma. It is also hoped the study will reveal ways of potentially halting the disease with gene therapies before it has the chance to fully develop.

Because information from White and Asian patients may not apply to African Americans, limiting the study to this population group should provide valuable genetic insights. This is important because glaucoma is particularly devastating to African Americans, yet most of the research in glaucoma so far has involved White patients. The data show that Black people are five times more likely than White people to develop glaucoma and that their disease develops up to 10 years earlier.

Surgery & Lasers

The future is now for robot-assisted glaucoma surgery

The first robotic gonio surgery system was developed in the heat of the pandemic in 2020 by the ophthalmology innovation team at New York Eye and Ear Infirmary of Mount Sinai in New York, New York.

This novel surgical system could dramatically improve outcomes for patients with glaucoma with its remarkable level of precision that is unachievable during standard glaucoma surgery.

The glaucoma module of the system is the first surgical application outside retina for the Preceyes robotic system, which was first CE marked in 2019 in Europe and is heading toward FDA studies in the United States.

Surgical system designed to create precise goniotomies

Streamline, a single-use device featuring the intuitive ClickPulse technology, is a first-line implant-free system designed to create precise goniotomies in the trabecular meshwork and deliver small amounts of ophthalmic viscosurgical device (OVD) into the canal of Schlemm in one unified step.

The device offers surgeons a unique option that can be used as a stand-alone procedure or combined with cataract surgery. Streamline received 510k clearance from the FDA on October 8, 2021, prompting New World Medical, a global medical device company focused on glaucoma interventions, to initiate a limited soft launch plan that includes building experience amongst select U.S. surgeons and commencing Phase 4 clinical studies.

Combining laser with minimally invasive glaucoma surgery to impact IOP

For patients with early-to-moderate glaucoma, administering laser with several minimally invasive glaucoma surgeries (MIGS) can minimise adverse effects. In over 90% of cases, combining MicroPulse cyclophotocoagulation (CPC) as well as a canaloplasty and a trabecular meshwork bypass is additive.

Biometric changes and endothelial cell loss after deep sclerectomy and trabeculectomy

In recent decades, safety concerns have fuelled progress in glaucoma surgery techniques. Standard trabeculectomy has well-known complications such as hypotony; choroidal detachment; flat anterior chamber; hyphema; acute or late endophthalmitis; and, in some cases, surgery-induced cataract.

Many new methods, including non-penetrating surgical procedures, have been developed in the search for an alternative approach. Deep sclerectomy has become one of the most widely used non-penetrating surgeries in primary open-angle glaucoma, and there is good evidence as to its efficacy and safety.

Eye Drops

TearClear initiates Phase 3 clinical trial of TC-002

TearClear’s CLEAR Study Phase 3 trial is a prospective, double-masked, randomly assigned, multi-centre, active-controlled, parallel-group, 3-month study assessing the safety and ocular hypotensive efficacy of TC-002 ophthalmic solution (TearClear Preservative-Free Latanoprost Ophthalmic Solution 0.005%) compared to marketed Latanoprost Ophthalmic Solution 0.005%.

According to the company, it has developed a novel investigational platform through which topical ophthalmic solutions are preserved in a patient-friendly multi-dose bottle but are delivered to the ocular surface as preservative-free.