New Glaucoma Technology

By James B. Wanner, OD

Maryland Eye Associates

. http://marylandeyeassociates.com

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New Glaucoma Technology

The diagnosis and treatment of glaucoma has come a long way over the past several decades, but has a lot of room for improvement and innovation. New technology is constantly being thought of and tested on both the diagnostic-side as well as the treatment-side.

Lowering the pressure inside the eye has traditionally treated glaucoma. By lowering the pressure inside the eye, the natural progression of the disease is slowed down. Lowering the eye pressure to treat glaucoma has been shown in many large studies to be an effective treatment.

Current treatments include topical and oral medications, as well as laser treatments and ocular surgery.

The most common treatment is topical medications, in the form of eye drops. We have several classes of these medications and often several different medications within each class. The major classes of these medications have been around for many years and generics are now available in all of these classes.

There are several new medications being studied at this time for glaucoma. There has not been a new class of glaucoma medications since the mid-90's. One such medication class is “Rho kinase (ROCK) inhibitors.” This class of medications theoretically works on the cells of the trabecular meshwork to improve drainage.

The theory is that the medication decreases the rigidity of the meshwork. The trabecular meshwork is where the aqueous humor (clear fluid in the eye) passes through as it leaves the eye and eventually reaches the venoussystem. This class of medication is being studied alone and as a combination medication with existing drugs.

Another study is looking at combining an existing medication, latanoprost, and nitric oxide. This combination may be more effective then latanoprost alone.

Besides studying new glaucoma medications there are also new delivery systems being evaluated for existing medications. One such delivery system being investigated is an extended release of medication in a punctual plug that would rest in the puncta of the eyelid.

We have four puncta (openings in our eyelids) that naturally drain our tears to our nasal passage and then to our throat. Punctal plugs have been around for many years and are used in treating dry eyes by damming up the drainage system. Now investigators are studying puttingglaucoma medications in these plugs that could be released over time.

The medication in the plug would need to be replaced periodically. The medications used for this would need to be stable over time. These plugs can fall out in which case the patient may be without treatment for some period of time. Implantable medication delivery systems are also being investigated. This could be an implant in the vitreous cavity or under the conjunctiva.

Besides new medications and new delivery systems there are also new surgical approaches to glaucoma. Some have been approved under certain circumstances and others are still being investigated for use in the United States. In addition to long standing surgical options for glaucoma, some newer surgical treatments include Canaloplasty, Ex-press mini-shunt, Trabectome, and iStent Trabecular bypass. Another potential surgical treatment being investigated is Suprachoroidal shunts. All of these new surgical options have different advantages and disadvantages.

The potential for new glaucoma treatment options include new medications, new delivery systems and new surgical options. This is an exciting time for glaucoma treatment research. Hopefully many of these treatment options help us to fight blindness from glaucoma going forward.