World Glaucoma Week: Celebrating strides in surgical techniques and therapeutics

Recent innovations in glaucoma have helped clinicians and patients manage the condition more effectively.

Between 6 and 12 March, 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.

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

Robot-assisted glaucoma surgery brings a taste of the future to today

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.

Investigating best practices for MicroPulse transscleral therapy for glaucoma

Dr Robert J. Noecker discusses the IRIDEX consensus paper regarding MicroPulse transscleral therapy for glaucoma. This paper tackles the best practices and treatment settings for the IRIDEX MicroPulse transscleral therapy for glaucoma.

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.

Newer CPC laser technologies are improving glaucoma outcomes

Ophthalmologists have seen a progression in cyclophotocoagulation, with each generation of the technology becoming more doctor- and patient-friendly.

“This latest generation of the technology allows identification of the ciliary process locations either before or at the time of treatment,” said Dr Shan Lin, a glaucoma specialist at the Glaucoma Center of San Francisco in California, United States. He explained that the locations of the ciliary processes can vary among the different ocular quadrants and among different patients with glaucoma. He cited a study reporting that they can range from 2–5 mm behind the limbus.

Achieving more predictable visual recovery following glaucoma surgery

The marvel of MIGS—and the reason we push them earlier in the disease course—is their safety and predictable postoperative recovery. In the past, we had fewer options, most of which were more invasive.

As a result, we had to delay surgery for years while patients suffered the discomfort, inconvenience and expense of multiple medications, until finally those medications were no longer enough and surgery was unavoidable. Now we can skip years of suffering and better manage glaucoma by making MIGS part of the treatment equation.

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.

Leave the drops behind: Finding the glaucoma treatment that is best for your patient

The glaucoma toolbox is expanding to include laser, drug delivery systems and minimally invasive glaucoma surgery.

Patient adherence has historically been low or nonexistent due to a number of factors, and the reason for the advent of so many new technologies in the subspecialty.

Considering this, Dr Inder Paul Singh explained his newly adopted philosophy. Glaucoma progression and controlled glaucoma are defined by IOP, visual fields, and the optic nerve, but he has added quality of life to the mix. Patients with ocular tearing, redness, and crusting are not adherent and do not have controlled glaucoma.

His new treatment regimen starts with selective laser trabeculoplasty (SLT) as the first-line therapy, followed by MIGS and laser or subconjunctival MIGS. He uses drug delivery and medication as needed. All the therapies can be used at the time that is best for dealing with adherence, he explained.

Industry News

Heidelberg Engineering becomes member of Glaucoma/Myopia OCT Phenotyping Consortium

Heidelberg Engineering is serving as a member of the Glaucoma/Myopia OCT Phenotyping Consortium (GMOPC), in an effort to support research to improve the detection of glaucoma, the world´s leading cause of irreversible vision loss.

The GMOPC was established in February 2020 at an inaugural meeting in Los Angeles, California, as an investigator-initiated clinical research study, with Heidelberg Engineering as an industry partner.

Aerie, Santen create commercialization and development agreement for Rhopressa, Rocklatan

Aerie Pharmaceuticals Inc. has entered into an exclusive development and commercialization agreement with Santen for netarsudil ophthalmic solution 0.02% (Rhopressa/Rhokiinsa) and netarsudil and latanoprost ophthalmic solution 0.02%/0.005% (Rocklatan/Roclanda).

According to the companies, the expanded collaboration includes Europe, Commonwealth of Independent States (CIS) countries, China, India, parts of Latin America and the Oceania countries.