National Glaucoma Research Report: Fall 2018
In This Issue...
- Two New Glaucoma Medications:
New approaches to lowering eye pressure
- President’s Corner
- Spotlight On … Hyungsik Lim, PhD
- How Eye Pressure is Measured
- Clinical Trials Myth Busters
- New Recipe: Baked Zucchini Chips
- What is Legal Blindness?
Two New Glaucoma Medications
New approaches to lowering eye pressure
In late 2017, the FDA approved two new medications for lowering eye pressure. Unlike other treatments available, these new options directly target the diseased tissue in glaucoma, the trabecular meshwork. Current medications reduce eye pressure either by increasing outflow of the aqueous humor or decreasing the inflow without affecting the trabecular meshwork.
The first new medication, Vyzulta™, is already available to patients and is the first nitric oxide-containing medication for glaucoma treatment worldwide. It releases nitric oxide, which is thought to relax the trabecular meshwork to increase drainage of aqueous humor and improve outflow. Vyzulta is taken as one drop every evening, similar to the delivery method of other current glaucoma drugs. Patients who are already using other medications can talk with their eye doctor to see if switching to Vyzulta would result in improved lowering of eye pressure.
Rhopressa® is the other new option and is included in a novel class of medications called rho-associated protein kinase inhibitors, or ROCK inhibitors. These medications lower eye pressure by relaxing the trabecular meshwork to decrease resistance to drainage in the connection passageway, called Schlemm’s canal. In addition to its effect on improving drainage, Rhopressa also decreases aqueous humor production. Dosed twice-daily, Rhopressa will be available for those with access to Medicare or Medicaid in January of 2019, but may be available through other insurance plans earlier.
Currently undergoing a clinical trial is a combination drop that combines the ROCK inhibitor netarsudil with latanoprost (Roclatan™). Dosed only once a day, this option is on track to launch in 2019 in the United States.
Without knowing its official name, you’ve likely had your eyes tested with a Goldmann applanation tonometer many times. (See page 3.) So have millions of other people over the last 50 years. And just like so much of the research being done in laboratories today, the Goldmann applanation tonometer was at one time, just an idea.
That’s why, every time we spotlight a researcher like Dr. Hyungsik Lim, whose National Glaucoma Research funded work is featured in this issue of National Glaucoma Research Report, I can’t help but wonder what role this discovery will play in the history of glaucoma research.
I’m optimistic that the research made possible because of your gifts will be noted years from now as playing significant turning points in the fight against glaucoma. Please continue to support these efforts as generously as you can. We all want the day where glaucoma is no longer robbing people of their vision to get here as soon as possible!
Spotlight On... Hyungsik Lim, PhD
New Imaging Technique to Better Detect Abnormal Retinal Nerve Changes
New technique may increase understanding of how glaucoma occurs
While diagnosing glaucoma early enough to prevent further vision loss is not possible today, there is hope. Dr. Hyungsik Lim and his colleague, Dr. John Danias, Hunter College, CUNY (New York, NY) have discovered a new way of imaging retinal nerves that is particularly useful for identifying the subtle changes associated with glaucoma. The project, funded by National Glaucoma Research, used this new technique to understand how glaucoma occurs, using animal models of glaucoma.
By using this advanced imaging, it is possible to monitor the eye’s microtubules—which are essentially the structural “scaffolding” of cells. The microtubules are an important element in the retinal nerves and glaucoma disrupts them at very early stages of the disease. Dr. Lim’s technique uses image comparisons, engineering, and mathematics to visualize retinal nerve fiber changes for early detection without the need for invasive imaging contrast drugs. This is the first time this technique has been applied to glaucoma research.
How Eye Pressure is Measured
Eye pressure can be evaluated several ways and is an important measurement ophthalmologists use when evaluating eye health. While other options are available and new methods are in development, these are the four primary ways currently used in ophthalmologists’ offices:
- Goldmann applanation tonometry – Eyes are anesthetized with numbing drops and a small amount of non-toxic dye is placed in the eye. The head is then placed in a device called a slit lamp. A small tip gently touches the surface of the eye to measure pressure based on the force required to gently flatten a fixed area of the cornea. Cornea thickness may influence results.
- Pneumatonometry - is particularly useful in cases of scarred corneas. It also uses numbing drops, but without dye. The pneumatonometer prints out a tracing so that the quality of the measurement can be assessed. This method is thought to be less influenced by corneal thickness.
- Rebound Tonometry – uses a small plastic-tipped probe that bounces gently against the cornea. Numbing drops are not required for this measurement and it is available as a portable device that can be used at home, which may be easier for some patients.
- Air-Puff Tonometry – is a non-contact test that uses a rapid air pulse to applanate (flatten) the cornea. Although there is some controversy about its accuracy, modern devices have been shown to correlate
Clinical Trials Myth Busters
Clinical trials play a critical role in scientific research seeking a cure for glaucoma. There are often common misperceptions about these clinical trials. Learn more about the myth versus the reality:
Myth 1: I can’t participate in clinical trials because of my age or my health.
Reality: Each trial has its own criteria for who can take part, and even if you don’t qualify for one trial you’re interested in, a different trial may be a match for you.
Myth 2: Taking part in a clinical trial is too time-consuming.
Reality: Some clinical trials do require regular visits or overnight stays, while others may have visits only every few months. Some trials are even conducted virtually. Ask about the time commitment to see if it is right for you.
Myth 3: Clinical trials are too risky.
Reality: It is important to weigh the benefits against the risk. Possible risks include drug side effects, and that the drug doesn’t work. Benefits include the possibility that the treatment will help research and improve the standard of care.
Myth 4: Once I join a clinical trial, I can’t quit if I want to
Reality: All trial participants are free to leave a trial at any time, for any reason.
Myth 5: Clinical trials are only a last resort.
Reality: Clinical trials can offer an option for those who have exhausted other treatments, or you can choose to participate if you’re unhappy with your current options. Many people also choose to participate to help medical research in their condition.
To learn more about participating in a glaucoma clinical trial near you, please visit our clinical trial finder, powered by Antidote, at brightfocus.org/GlaucomaTrials.
Baked Zucchini Chips
A tasty, healthier alternative to potato chips, zucchini chips are light, crisp, and easy to make! Only a few minutes of prep time needed and the oven does the rest!
2 large zucchinis, thinly sliced
1 tablespoon olive oil sea salt to taste.
- Preheat oven to 250 F.
- Arrange sliced zucchini on a baking sheet. Drizzle lightly with olive oil and sprinkle lightly with sea salt.
- Bake in the preheated oven until completely dried and chip-like, about one hour per side. Allow to cool before serving.
What is Legal Blindness?
Legal blindness is defined in the United States as best corrected visual acuity (with glasses) of 20/200 or less in the better eye, and/or a visual field of 20 degrees or less. People with legal blindness may still have some usable vision.
The greatest fear of patients with eye disease is going “blind.” While there are a number of eye diseases, including glaucoma, which can lead to some form of vision impairment, each can affect different aspects of vision. For example, if glaucoma is left untreated, the narrowing of the vision field eventually leads to blindness. With earlier diagnosis and treatment, the progression of that loss of the visual field could be slowed or stopped, preserving vision as much as possible
Thank you for supporting National Glaucoma Research!
Please share this newsletter with someone who might be interested in learning more about some of the latest advancements in research to diagnose, prevent, treat, and cure glaucoma. This newsletter is published by National Glaucoma Research, a program of BrightFocus Foundation, a nonprofit organization located at 22512 Gateway Center Drive, Clarksburg, Maryland 20871, 301-948-3244, brightfocus.org.
The information in National Glaucoma Research Report is provided as a public service and should not in any way substitute for the advice of a qualified health care professional, nor is it intended to constitute medical advice. BrightFocus Foundation does not endorse any medical product or therapy. Copies of this newsletter are available upon request.
National Glaucoma Research is a program of BrightFocus Foundation, a charitable organization that complies with all 20 rigorous BBB Wise Giving Alliance Standards.
A Healthy Lifestyle Promotes Eye Health
For people with glaucoma or at risk of developing it, a healthy lifestyle that includes a nutritious diet and regular exercise is especially important.
- Enjoy plenty of dark green, yellow, and orange fruits and vegetables, packed with eye-healthy nutrients.
- Exercise daily. Aerobic activities such as walking, swimming, or yard work are recommended. Contact your physician before beginning any exercise program.
- Wear wide-brimmed hats and high-quality sunglasses with 99-100% UVA and UVB protection.
- Quit smoking. Smoking increases blood pressure and inflammation in the eye, which can lead to cataracts and diabetes, both risk factors for glaucoma.
- Keep blood pressure at a normal level.
For more eye-healthy tips, visit brightfocus.org/NGR.
Warning Signs for Glaucoma
Early detection and treatment are key to saving your sight from glaucoma— be sure to have regular eye exams as directed by your doctor.
Open-angle glaucoma (the most predominant form), normal-tension glaucoma, and chronic angle-closure glaucoma have no symptoms until damage to the eye occurs, making early detection and treatment even more crucial.
Acute angle-closure glaucoma is a medical emergency and must be treated immediately or blindness could result in one or two days.
Symptoms may include:
- Severe pain
- Blurred vision
- Rainbow halo around lights
Learn more about glaucoma at brightfocus.org/NGR.