Current and new pharmacotherapeutic approaches for glaucoma

ABSTRACT

Introduction

Glaucoma is the leading cause of irreversible blindness worldwide. Medical therapy is the main line of treatment of open-angle glaucoma (OAG) and ocular hypertension. Despite the expansion of the glaucoma lineup with the newly approved medication classes, many barriers and issues still exist with topical therapy. Novel non-topical drug delivery may address such issues, adding more options to glaucoma pharmacotherapy.

Areas Covered

This review outlines current topical therapies for glaucoma, in addition to new medications under trials. The issues with topical therapy, in general, are discussed, as well as the new non-topical drug delivery systems. The authors performed a comprehensive search for published studies on glaucoma medical therapy using the electronic database of PubMed and manual search for each medication and non-topical delivery options. The extra- and intraocular delivery methods and the new topical glaucoma medications under research are covered.

Expert opinion

Medical management of glaucoma represents a challenge for both patients and clinicians. Noncompliance (e.g. difficulty with administering the eye drops), cost, side effects, and intraocular pressure fluctuation are the major problems with topical therapy. To overcome such barriers, research should continue in developing new medications and innovation of non-topical drug delivery systems.

KEYWORDS:

• Drug delivery
• glaucoma
• medical therapy
• ocular hypertension
• pharmacotherapy

Article highlights

• Medical therapy is the main line of treatment of open-angle glaucoma and ocular hypertension.

• Current topical medications have been expanded with FDA approval of nitric oxide donating prostaglandins and rho kinase inhibitors.

• Non-adherence, cost burden, and side effects like ocular surface damage remain issues with topical therapy.

• Several novel medications including, prostanoid receptor agonists and oligonucleotide-based compounds, are in their late stages of development.

• The recent FDA approval of intracameral bimatoprost SR implant may be the beginning of a new treatment era in the glaucoma management and we may have more peri- and intraocular medication delivery systems in the future.

This box summarizes the key points contained in the article.

Declaration of interest

LJ Katz receives research grants and support from Heidelberg Engineering, and Zeiss. JL Katz is a consultant and/or on the advisory board of Allergan, and Bausch and Lomb. He is also a speaker for Allergan, Glaukos, and Bausch & Lomb. Furthermore, he is a stock shareholder for Glaukos, Mati Therapeutics, Aerie, and Olleyes. Finally, he is a Chief Medical Officer for Glaukos. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.