University of California, San Francisco, UCSF Medical Center
Learn about several recently approved glaucoma medications and innovative methods to deliver these drugs into the eye.
It is an exciting era for glaucoma treatments and drug delivery systems. In 2018, the first new glaucoma medications with novel mechanisms of action were FDA approved, the prior being over 20 years ago when latanoprost (Xalatan®) was introduced. These new medications included netarsudil (Rhopressa) and latanoprostene bunod (Vyzulta).
In March 2019, Rocklatan, which is a combination drug Rhopressa with latanoprost, was approved by the FDA and is now available. The excitement about Rocklatan is that clinical trials demonstrated that this combination drop used once daily is more effective at lowering eye pressure compared to either of its ingredients alone. One of the ingredients in the combination drop is latanoprost, which is the world’s top-selling eye drop. In comparison, this new eyedrop, Rocklatan, is more effective at eye pressure lowering than the leading eyedrop. From my perspective, Rocklatan is also attractive because it decreases eye pressure by many different mechanisms. However, just as with Rhopressa, Rocklatan can cause eye redness, which some patients may not be able to tolerate.
While there are many laboratories and companies that are investigating the potential of glaucoma medications that go beyond eye pressure lowering, such as protecting the optic nerve (also called “neuroprotection”), given that these are still currently in early stages the rest of this article will focus on some new ways of delivering eye pressure-lowering eye drops.
This discussion will not be all-inclusive, but will provide a sense of the innovative and exciting possibilities that lie ahead for people who have glaucoma. It is also important to note that laser treatment is a very appropriate and potentially better first-line treatment compared to medications. A previous article compared laser treatment and eye drops.
Many of my patients are worried about whether they have properly instilled their eyedrops when they feel the drops rolling down their faces. I reassure them that they still received a proper dose because a single eyedrop is actually more than the eye can handle or absorb.
A new option is being advanced, called microdrops or microdoses, which is the concept behind an eye drop delivery system being developed by Eyenovia for several different eye diseases, including glaucoma. The attraction for glaucoma patients is that not only are the excess eyedrops not wasted but also that there is the potential for reduced side effects induced by glaucoma drops.
What if people with glaucoma didn’t even have to instill eyedrops using a bottle? There are several companies that are developing plugs that are placed by an ophthalmologist in the tear ducts of the eye (punctal plugs) that will slowly release the eyedrop onto the surface of the eye. Punctal plugs are already used for patients with dry eye, so we already know that punctal plugs can be used. The advantage of a punctal plug that releases the eye drop is that patients would not have to remember to use their eyedrops every day. One disadvantage is that sometimes the plugs fall out, and the downside is that then the patient would be missing their medications without knowing it.
Another drug delivery system in development is a device that is injected into the eye, and it would also slowly release medication over time. The advantage of this system over the punctal plug is that it can’t be lost since it’s inside the eye. On the other hand, it does require an injection (done in a clinic) and carries with it a risk of infection. There are several other examples of drug injectables already used for other eye diseases, so there is great promise for this new way of delivering medications to glaucoma patients.
This article is not comprehensive in its discussion of new glaucoma drugs and delivery systems in the pipeline, but aims to give an overview of some of the exciting prospects on the horizon to improve glaucoma patient care.
Yvonne Ou, MD, is a board certified ophthalmologist who specializes in glaucoma, including medical, laser and surgical therapies; cataract evaluation and treatment including combined cataract and glaucoma surgery; glaucoma filtering and implant surgery; and newer procedures.
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