Glaucoma Therapy Research Articles

RIP1 inhibition protects retinal ganglion cells in glaucoma models of ocular injury

AbstractReceptor-interacting protein 1 (RIP1, RIPK1) is a critical mediator of multiple signaling pathways that promote inflammatory responses and cell death. The kinase activity of RIP1 contributes to the pathogenesis of a number of inflammatory and neurodegenerative diseases. However, the role of RIP1 in retinopathies remains unclear. This study demonstrates that RIP1 inhibition protects retinal ganglion cells (RGCs) in preclinical glaucoma models. Genetic inactivation of RIP1 improves RGC survival and preserves retinal function in the preclinical glaucoma models of optic nerve crush (ONC) and ischemia–reperfusion injury (IRI). In addition, the involvement of necroptosis in ONC and IRI glaucoma models was examined by utilizing RIP1 kinase-dead (RIP1-KD), RIP3 knockout (RIP3-KO), and MLKL knockout (MLKL-KO) mice. The number of RGCs, retinal thickness, and visual acuity were rescued in RIP1-kinase-dead (RIP1-KD) mice in both models, while wild-type (WT) mice experienced significant retinal thinning, RGC loss, and vision impairment. RIP3-KO and MLKL-KO mice showed moderate protective effects in the IRI model and limited in the ONC model. Furthermore, we confirmed that a glaucoma causative mutation in optineurin, OPTN-E50K, sensitizes cells to RIP1-mediated inflammatory cell death. RIP1 inhibition reduces RGC death and axonal degeneration following IRI in mice expressing OPTN-WT and OPTN-E50K variant mice. We demonstrate that RIP1 inactivation suppressed microglial infiltration in the RGC layer following glaucomatous damage. Finally, this study highlights that human glaucomatous retinas exhibit elevated levels of TNF and RIP3 mRNA and microglia infiltration, thus demonstrating the role of neuroinflammation in glaucoma pathogenesis. Altogether, these data indicate that RIP1 plays an important role in modulating neuroinflammation and that inhibiting RIP1 activity may provide a neuroprotective therapy for glaucoma.

Application of transcranial magnetotherapy in the treatment of glaucoma

The term "glaucoma" unites a large group of eye diseases with a characteristic pathogenesis and clinical picture, but different aetiology. Modern classifications group the different forms of glaucoma according to origin, age of the patient, mechanism of intraocular pressure increase and its level, degree of optic disc damage and course of the disease. The disease is a significant medical and social problem, as it affects large population groups worldwide and is the leading cause of irreversible blindness. Every year the number of glaucoma patients of working age increases, and the presence of concomitant diseases in patients complements and complicates the clinical picture and course of the main pathological process. To date, high therapeutic effectiveness of electromagnetic fields in glaucoma treatment has been determined and proved, specific methods of procedures have been developed, and the list of indications for their prescription is expanding. The purpose of the review is to present the possibilities of using transcranial magnetic therapy in the treatment of glaucoma. The authors, based on available scientific data and their own clinical observations, summarizes information regarding the use of transcranial magnetic therapy for glaucoma. Indications and contraindications for transcranial magnetic therapy are outlined. The principles of prescribing various methods of transcranial magnetic therapy are covered in detail. The characteristics of the equipment used for transcranial magnetic therapy procedures are given. In general, physical therapeutic factors play an important role in the overall complex of therapeutic and preventive measures in the treatment of eye diseases. As methods of external influence they have a direct impact on etiological and pathogenetic mechanisms, as well as on the symptoms of the disease.

Green-Light-Triggered and Self-Calibrated Cascade Release of Nitric Oxide and Carbon Monoxide for Synergistic Glaucoma Therapy.

Glaucoma is an optic degenerative neuropathy that is driven by a vicious cycle of oxidative stress and mechanical stress. Current clinical treatments aim exclusively at alleviating mechanical stress by reducing the intraocular pressure (IOP). With the unattended oxidative stress, recurrence and deterioration of mechanical stress are inevitable. Nitric oxide (NO) and carbon monoxide (CO) are endogenous gaseous signaling molecules for vasodilation and anti-inflammation, respectively. Mounting evidence suggests an intricate interplay between NO and CO to mediate their biological roles, like how it takes two to dance a waltz. This leads to the concept of "gas waltz therapy" for glaucoma, in which NO is released to reduce IOP and stoichiometric CO is coreleased to suppress oxidative stress. CND570 is the first phototriggered cascade NO/CO donor, to the best of our knowledge. Notably, the release of NO/CO is accompanied by the concomitant release of a rhodamine dye whose bright fluorescence is harnessed as a convenient calibration mechanism of the gas release profile. CND570 exhibits excellent transcorneal permeability and reaches the target aqueous humor outflow pathway. Further, green-light irradiation triggers release of CO and NO in the eye tissue of glaucoma mice. NO and CO could promote the upregulation of soluble guanylate cyclase (sGC) in both in vitro and in vivo models. Notably, CND570 treatment significantly reduces the oxidative stress associated with glaucoma. NO/CO-based gas waltz therapy is a promising new avenue for glaucoma treatment.

A Mini-Review on Gene Therapy in Glaucoma and Future Directions

Glaucoma is a group of optic neuropathies characterized by the degeneration of retinal ganglion cells and the loss of their axons in the optic nerve. The only approved therapies for the treatment of glaucoma are topical medications and surgical procedures aimed at lowering intraocular pressure. Gene therapy involves the insertion, removal, or modification of genetic material within cells to repair or compensate for the loss of a gene’s function. It describes a process or technology that enables the genetic modification of cells to produce a therapeutic effect. However, changing the genetic material alone does not extend the duration of overexpression of proteins that combat disease, nor does it facilitate the production of new proteins for this purpose. We reviewed the literature concerning the use of gene therapy in the treatment of glaucoma and explored the future directions that this innovation may offer. Three genes associated with glaucoma have been identified within these loci: myocilin/trabecular meshwork glucocorticoid response (TIGR) (GLC1A), optineurin (GLC1E), and WDR36 (GLC1G). Among these, the most extensively studied glaucoma gene is myocilin (a TM-inducible glucocorticoid response gene). Building on previous successes, researchers have begun to apply genetic therapeutic approaches to alleviate or reduce symptoms associated with ocular hypertension (OHT) and glaucoma-like optic neuropathy (GON). It is evident that several therapeutic strategies exist that modulate aqueous humor production and flow, thereby regulating intraocular pressure (IOP) and protecting retinal ganglion cells (RGCs) from apoptosis. With the emergence of gene therapy as a potentially viable approach to preserving vision, new methods for managing glaucoma may soon become available. Genomic therapy is a promising treatment option for glaucoma patients and has significant potential for widespread clinical application.

Acupuncture as Adjuvant Therapy for Glaucoma: Protocol for a Randomized Controlled Trial.

Glaucoma is a chronic progressive optic neuropathy that necessitates lifelong treatment to reduce the decline of the optic nerve. Due to the extended and continuous treatments required for patients, complementary therapies are often considered alongside conventional treatments to enhance the effectiveness of the treatment. Acupuncture has demonstrated the potential to lower intraocular pressure in previous clinical trials, making it a promising glaucoma intervention. The primary objective of this study is to conduct a single-center randomized control trial involving patients with glaucoma. Acupuncture will be evaluated as an adjunctive therapy. The trial aims to explore its effectiveness for glaucoma. In this single-center randomized controlled trial, participants (N=50) with primary open-angle glaucoma will be randomly assigned to the treatment group, receiving ophthalmic acupuncture with "De Qi" sensation, or the control group, receiving minimum acupuncture stimulation on nonophthalmic acupoints. The intervention will consist of weekly acupuncture treatments for a total of 6 sessions. Participants will be assessed at 8 time points, which are baseline, during the intervention (6 times), and at a 3-month follow-up. The primary outcome measure is a change in the intraocular pressure before and after each acupuncture treatment. Secondary outcomes will include measurements of heart rate and blood pressure before and after acupuncture, best-corrected visual acuity, visual field, optical coherence tomography, optical coherence tomography angiography, the Glaucoma Symptom Scale, and the Glaucoma Quality of Life-15 questionnaire. Recruitment of participants for the trial commenced on June 28, 2023. A total of 10 participants have been enrolled to test the feasibility of the experiment. We anticipate that the preliminary data from this trial will be completed by December 2025. This trial uses rigorous methodology and comprehensive outcome measurements to assess the clinical efficacy of acupuncture as an adjunctive therapy for glaucoma, providing valuable insights for future clinical treatment guidelines. ClinicalTrials.gov NCT05753137; https://clinicaltrials.gov/study/NCT05753137. DERR1-10.2196/57888.

Social media content analysis for nutraceuticals and glaucoma.

Google and various social media platforms have content on the therapeutic potential of nutritional supplements for glaucoma, but whether that information is evidence-based has not been analyzed. The current study explores such content for its quality. Criteria of search used were "glaucoma" and "vitamins" or "nutraceuticals" or "nutritional supplements". The first 30 search results on Google for every keyword combination were determined. The top 30 video results on Facebook Watch and YouTube for each keyword combination were selected. The initial 30 posts from Reddit and the top 30 Images on Google Images related to the keyword combination were also examined. Sixty-eight websites on Google, 75 Images from Google, 39 YouTube videos, 12 video results from Facebook Watch, and 19 posts from Reddit were identified and assessed for quality.The average Sandvik scores were 10.86 ± 2.6 (Google webpages), 10.08 ± 1.9 (YouTube videos), 10.62 ± 1.6 (Facebook Watch), and 10.26 ± 2.8 (Posts from Reddit). The average Risk Scores were 0.67 ± 0.9 (videos from YouTube), 0.49 ± 0.8 (webpages on Google), 0.33 ± 0.5 (videos from Facebook Watch), and 0.26 ± 0.5 (Reddit). The mean HON code scores were 5.15 ± 1.5 (YouTube), 6 ± 1.7 (Google webpages), 4.42 ± 1.1 (Facebook Watch), and 3.47 ± 1.8 (Reddit). Many patients who seek information online do not consult their physicians to verify the accuracy of their search results. Thus, with this changing trend, video and online medical content analysis has attracted interest. Search engines and social media platforms may serve as adjuncts for patient counseling in current care models by providing an online educational community. Compared to non-healthcare professionals, the healthcare professionals' information regarding nutraceuticals/nutritional supplements in glaucoma is of higher quality. Most HCPs do not recommend the use of dietary supplements as a complementary treatment for glaucoma, either because of inconclusive/insufficient data or due to contrasting studies that contradict each other. However, literature is building up with each passing day, to support nutritional supplementation as an integrative IOP-independent strategy for glaucoma management. The information provided by healthcare professionals is superior to that offered by non-healthcare professionals. Most HCPs advise against the use of nutritional supplements as an adjunct therapy for glaucoma, either because of inconclusive data or due to contrasting studies that contradict each other.

Development of Nitric Oxide-Donating Netarsudil Derivatives as a Synergistic Therapy for Glaucoma with Reduced Ocular Irritation.

Based on the synergistic therapeutic effect of nitric oxide (NO) and Rho-associated protein kinase (ROCK) inhibitors on glaucoma, a series of NO-donating Netarsudil derivatives were designed, synthesized, and their activities in vitro and in vivo were evaluated. Among them, (S)-10e released an appropriate amount of NO in aqueous humor in vitro and displayed potent ROCK inhibition. Topical administration of (S)-10e significantly lowered intraocular pressure in an acute ocular hypertension rabbit model and protected retinal ganglion cells in a magnetic microbead occlusion mouse model. A metabolism investigation revealed that (S)-10e released 7a, a metabolite after NO releasing, and 13, an active metabolite of (S)-Netarsudil, in rabbit eyes. Notably, introducing an NO donor moiety attenuated ROCK inhibition-induced ocular irritation in an sGC-independent manner, suggesting that the attenuated conjunctival hyperemia effect of (S)-10e is related to the NO-induced protein S-nitrosation of phosphodiesterase 3A (PDE3A). Overall, (S)-10e is a promising candidate for glaucoma treatment.

Advancing Glaucoma Therapy by Exploring the Efficacy and Potential of Brimonidine Niosomal Gel

Glaucoma is a leading cause of permanent vision loss worldwide and is characterised by progressive optic neuropathy with elevated intraocular pressure (IOP) as a major risk factor. Although successful, the current therapeutic strategies are often severely limited by their need for chronic dosing, systemic side effects and poor patient compliance. Brimonidine, an alpha-2 adrenergic receptor agonist which acts selectively, has been beneficial through its IOP-lowering effects by diminishing aqueous humor production and improving uveoscleral outflow. A novel medication delivery technology to enhance ocular bioavailability and extended drug release is brimonidine, formulated as a niosomal gel. The aim of this study is to highlight its clinical efficacy, formulation strategies and mechanism of action that significantly improved glaucoma therapy. Key studies illuminate its potential benefits in reducing dosing frequency, avoiding side effects and increasing patient compliance. Additional study and optimization required to scale-up manufacturing or ensure long-term stability. Possible future directions: combination medications and delivery systems personalized medicine possible future directions in the treatment of glaucoma might include combination medicines and personalized medicine techniques tailored to patient-specific needs. Brimonidine niosomal gel may be a new approach for glaucoma management and it can change the concept of intraocular drug delivery in the future.

Progressive Thickening of Retinal Nerve Fiber and Ganglion Cell Complex Layers Following SDM Laser Vision Protection Therapy in Open-Angle Glaucoma.

This work aims to determine the effect on nerve fiber layer (NFL) and ganglion cell complex (GCC) thickness trends in eyes with open-angle glaucoma (OAG) treated with Vision Protection Therapy™ (VPT). A retrospective analysis of spectral-domain optical coherence tomography (OCT) measured NFL and GCC thickness trends was performed, excluding eyes with poor-quality scans and principal diagnoses other than OAG. This study compares eyes with OAG managed conventionally with IOP control alone (controls) to eyes managed with the addition of VPT (VPT eyes). The direction (+ or -) and magnitude (microns/year) of the OCT trends were the study endpoints. Seventy-eight control eyes of 40 patients and 61 VPT-treated eyes of 39 patients were included in the study. Positive NFL trends were noted in 5% of control eyes vs. 71% of VPT eyes (p < 0.0001). Positive GCC trends were noted in 8% of control eyes vs. 43% of VPT eyes (p < 0.0001). Mean NFL trends (µm/year) were - 0.692 for controls vs. 0.347 for VPT (p < 0.0001). Mean GCC trends (µm/year) were - 0.554 for controls vs. - 0.148 for VPT (p = 0.0175). The addition of VPT to the conventional management of OAG resulted in highly significant improvements in NFL and GCC trends, indicating a reversal of key indicators of glaucoma severity and progression.

A national analysis of systemic adverse events of beta-blockers used for glaucoma therapy

Purpose To evaluate systemic complications for timolol, carteolol, levobunolol, and/or betaxalol by using an FDA Federal Adverse Event Reporting System (FAERS) Methods We evaluated FAERS for adverse events associated with β-blocker use for glaucoma. All reported symptoms were reviewed to identify systemic adverse events and to detect safety signals, defined as information on a new or known side effect that may be caused by a medicine. We used the proportional reporting ratio (PRR), reporting odds ratio (ROR), empirical Bayes geometric mean (EBGM), and information component (IC) as a part of a disproportionality analysis comparing the frequency of β-blocker symptoms with all other adverse event reports. We considered a signal to be detected when all four disproportionality analysis metrics were positive. Results We found 10,500,309 total adverse event reports from the FAERS database 2004-2022Q3, which included 8,793 case reports with a primary suspect of a β-blocker use for glaucoma. 1,838 unique adverse symptoms were reported were associated with β-blocker. Regarding outcomes, there were 165 (1.88%) reports of disability, 671 (7.63%) reports of hospitalisation, and 1,934 (21.99%) reports of some other unspecified complication. Regarding adverse events, the most reported general, cardiac, and respiratory symptoms were respectively dizziness (n = 281), bradycardia (n = 145), and dyspnoea (n = 195). 256 (2.91%) cases of death were reported. We found significant signals on bradycardia (n = 145), complete atrioventricular block (n = 38), and bronchospasm (n = 23). No allergic, endocrine, constitutional, or gastrointestinal symptoms generated positive signals. Conclusion β-blocker use in glaucoma therapy can be rarely associated with serious systemic and life-threatening complications.

Role and mechanism of autonomic nervous system regulation in primary glaucoma

The regulation of blood flow in the human eye, aqueous humor production, and the outflow channels of aqueous humor are all controlled by the autonomic nervous system (ANS), encompassing both sympathetic and parasympathetic nerves. Patients with primary glaucoma often exhibit autonomic nervous system dysfunctions, which may exacerbate visual impairment. The homeostasis of the autonomic nervous system is influenced by circadian rhythms, physical exercise, emotional states, medications, and other factors. Previous studies have indicated that activities such as aerobic exercise, yoga breathing, and meditation can promote the restoration of autonomic nervous system balance, thereby reducing intraocular pressure. However, further evidence is required to substantiate the efficacy of ANS activity regulation as an effective adjunct therapy for primary glaucoma. This review examines the role and mechanisms of autonomic nervous system regulation in the context of primary glaucoma.

Glaucoma: Current and New Therapeutic Approaches.

Glaucoma is identified by the loss of retinal ganglion cells (RGCs). The primary approach to managing glaucoma is to control intraocular pressure (IOP). Lately, there has been an increasing focus on neuroprotective therapies for glaucoma because of the limited effectiveness of standard methods in reducing IOP and preventing ongoing vision deterioration in certain glaucoma patients. Various drug-based techniques with neuroprotective properties have demonstrated the ability to decrease the mortality of retinal ganglion cells. This study will analyze the currently recommended drug-based techniques for neuroprotection in the prospective treatment of glaucoma.

Impact of Sociodemographic and Psychological Factors on Adherence to Glaucoma Treatment - A Cross-Sectional Study.

Glaucoma is a group of eye diseases characterized by progressive and irreversible damage to the optic nerve. The aim of the study was to examine the impact of sociodemographic and psychological factors on adherence to glaucoma therapy. The study was carried out among 190 adults treated for glaucoma at the Ophthalmology Outpatient Clinic of the University Teaching Hospital in Wroclaw between January 2019 and September 2019. Treatment adherence was measured using the Adherence to Refills and Medications Scale (ARMS). We used the Acceptance of Illness Scale (AIS), the Revised Life Orientation Test (LOT-R) and the Satisfaction with Life Scale (SWLS). 58.9% patients reported low treatment adherence. Educated females aged 68 or under living in cities had higher adherence. The regression analysis showed an association between dispositional optimism and glaucoma treatment adherence. The higher the level of dispositional optimism, the better the adherence. Higher dispositional optimism is directly associated with a sense of self-esteem and self-efficacy and a feeling of internal control. Patients reporting a high level of illness acceptance were found to have 2.5 times higher odds of adhering to glaucoma therapy. Illness acceptance is an indicator of the degree of adaptation to an illness and is positively correlated with a sense of self-esteem and self-efficacy and engagement in healthy behavior. More than half of patients with glaucoma have low adherence. Sociodemographic characteristics (female gender, age 68 or under, tertiary education and living in an urban area) and psychological characteristics (high level of illness acceptance, dispositional optimism and satisfaction with life) are significant predictors of high adherence.

Engineered sensor actuator modulator as aqueous humor outflow actuator for gene therapy of primary open-angle glaucoma

Glaucoma, a blinding eye disease with optic neuropathy, is usually associated with elevated intraocular pressure (IOP). The currently available pharmacological and surgical treatments for glaucoma have significant limitations and side effects, which include systemic reactions to medications, patient non-compliance, eye infections, surgical device failure, and damage to the eye. Here, we present Sensor-Actuator-Modulator (SAM), an engineered double mutant version of the bacterial stretch-activated mechanosensitive channel of large conductance (MscL) that directly senses tension in the membrane lipid bilayer of cells and in response, transiently opens its large nonspecific pore to release cytoplasmic fluid. The heterologously expressed mechanosensitive SAM channel acts as a tension-activated pressure release valve in trabeculocytes. In the trabecular meshwork (TM), SAM is activated by membrane stretch caused by elevated IOP. We have identified several SAM variants that are activated at physiologically relevant pressures. Using this barogenetic technology, we have demonstrated that SAM is functional in cultured TM cells, and successfully transduced in vivo in TM cells by use of AAV2/8. Further, it is effective in enhancing aqueous humor outflow facility leading to lowering the IOP in a mouse model of ocular hypertension.

Intraocular Pressure Response to Perceived Stress in Juvenile-onset Open-angle Glaucoma.

High perceived stress from academic pressure is associated with intraocular pressure elevation and reduced fluctuation in juvenile-onset open-angle glaucoma patients. Personalized stress assessment and relief strategies may serve as an adjunct therapy in glaucoma. To evaluate the effect of higher perceived stress, resulting from academic pressure, on intraocular pressure (IOP) in juvenile-onset open-angle glaucoma (JOAG) patients compared to healthy individuals. The study included 48 university students aged 18 to 27, comprising 24 JOAG patients on antiglaucoma eyedrops and 24 healthy controls. In an examiner-blind pretest-posttest design, participants' IOP was measured weekly using Goldmann tonometry during three follow-up visits at the beginning and end of the academic semester. Perceived Stress Scale (PSS) scores were also evaluated at these two time points to capture the contrast in perceived stress between periods of low and high academic pressure. Baseline PSS score at the semester's start was lower in both groups (14.1±1.9 in glaucoma vs. 13.5±2.4 in control) and significantly increased by the end of the semester (29.2±2.1 vs. 28.5±1.3; P<0.001), indicating increased perceived stress. Concurrently, IOP rose from 22.01±5.87mmHg to 25.08±5.84mmHg in the glaucoma group and from 11.36±2.03mmHg to 13.65±2.11mmHg in the control group. Factorial analysis revealed a significant interaction between stress and JOAG [F(1,94)=15.94, P=0.001], partial η2=0.08, with stress having a greater increase on IOP in the glaucoma group (+3.10mmHg) compared to the control group (+2.23mmHg) [t(94)=4.457, P<0.001]. Higher perceived stress significantly increases IOP, especially in JOAG patients, suggesting personalised stress management as a potential adjunct therapy for patients.

Small extracellular vesicles derived from microRNA-22-3p-overexpressing mesenchymal stem cells protect retinal ganglion cells by regulating MAPK pathway

Glaucoma is the leading cause of irreversible blindness and is characterized by progressive retinal ganglion cell (RGC) loss and retinal nerve fiber layer thinning. Currently, no existing treatment is effective for the preservation of RGCs. MicroRNA-22-3p (miR22) and small extracellular vesicles derived from mesenchymal stem cells (MSC-sEVs) have neuroprotective effects. In this study, we apply miR22-overexpressing MSC-sEVs in an N-methyl-D-aspartic acid (NMDA)-induced RGC injury model to assess their short-term therapeutic effects and explore the underlying mechanisms. We find that mice in the miR22-sEVs-treated group have thicker retinas, fewer apoptotic cells, more reserved RGCs, better retinal function, and lower expression levels of Bax and caspase-3. MiR22-sEVs treatment promotes viability, inhibits apoptosis and inhibits Bax and caspase-3 expression in RGC-5 cells. MiR22 targets mitogen-activated protein kinase kinase kinase 12 to inhibit apoptosis by regulating the mitogen-activated protein kinase (MAPK) signaling pathway. Collectively, our results suggest that miR22-sEVs ameliorate NMDA-induced RGC injury through the inhibition of MAPK signaling pathway-mediated apoptosis, providing a potential therapy for glaucoma and other diseases that involve RGC damage.

The Impact of Baseline Intraocular Pressure on Initial Treatment Response in the LiGHT Trial: Selective Laser Trabeculoplasty versus Medication

The Laser in Glaucoma and Ocular Hypertension Trial demonstrated the efficacy and safety of selective laser trabeculoplasty (SLT) compared with topical hypotensive medication as first-line therapy for ocular hypertension and open-angle glaucoma. This substudy explored the impact of pretreatment (baseline) intraocular pressure (IOP) on treatment response. Post hoc analysis of randomized control trial data. A total of 1146 eyes from 662 patients were included in this analysis: 559 eyes in the SLT group and 587 in the medication group. Intraocular pressure reduction at 8 weeks after treatment with either SLT or prostaglandin analog (PGA) eye drops was assessed at different levels of baseline IOP, and the groups were compared. Differences in absolute and percentage IOP lowering between SLT and PGA groups were tested with a linear mixed-effects model. Differences in the probability of achieving ≥ 20% IOP lowering between SLT and PGA groups, at different levels of baseline IOP, were estimated using a logistic mixed-effects model. Intraocular pressure-lowering response to SLT versus PGA eye drops. Mean IOP was not significantly different between the groups at baseline or 8 weeks after treatment initiation. Both treatments showed greater IOP lowering at higher baseline IOP and less IOP lowering at lower baseline IOP. Selective laser trabeculoplasty tended to achieve more IOP lowering than PGA drops at higher baseline IOP. Prostaglandin analog drops performed better at lower baseline IOP, and the difference compared with SLT, in terms of percentage IOP reduction, was significant at baseline IOP of ≤ 17 mmHg. A significant difference was found in the relationship between baseline IOP and probability of ≥ 20% IOP lowering between the two treatments (P= 0.01), with SLT being more successful than PGA at baseline IOP of more than 22.5 mmHg. We confirm previous reports of greater IOP lowering with higher baseline IOP for both SLT and PGA drops. In treatment-naïve eyes, at higher baseline IOP, SLT was more successful at achieving ≥ 20% IOP lowering than PGA drops. At lower baseline IOP, a statistically greater percentage, but not absolute, IOP lowering was seen with PGA drops compared with SLT, although the clinical significance of this is uncertain. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Advances in Glaucoma Drug Therapy

Abstract Glaucoma remains the leading cause of irreversible blindness, but timely treatment to lower intraocular pressure is effective at slowing the rate of vision loss from glaucoma. Medical management remains the first line of treatment in adult glaucoma, and the evolution of medical therapy for glaucoma has followed an exponential curve. This narrative review briefs the rapid development of new medications and drug delivery systems in recent years. Newer medications may be able to extend the duration of medically controlled glaucoma, delaying or possibly eliminating the need for glaucoma surgery for some patients. Alternative methods of delivery for glaucoma medications may be a key factor in improving outcomes with currently available medications.

Ways to improve the effectiveness of glaucoma filtering surgery

The article presents a variety of ways to increase the efficiency of glaucoma filtering surgery. Special attention is given to maintaining the ocular surface healthy through optimal glaucoma therapy. The duration of the disease should be taken into account when choosing the type of hypotensive surgery and designing an algorithm for its pharmacological support: preoperative preparation, prolonged postoperative anti-inflammatory treatment and cornea protection.

Sustained Release Therapies with the Prostaglandin Analogues Intracameral Implants.

The travoprost intracameral implant was recently approved by the US Food and Drug Administration for sustained release medical treatment of open-angle glaucoma in the USA. The approval represents a substantial and progressive step forward in the area of sustained-release glaucoma therapy. Topical intraocular pressure-lowering medications for the treatment of glaucoma are faced with a host of challenges for long-term and usually lifelong care. A changing paradigm in glaucoma management involves first-line interventions with laser modalities, micro-invasive surgeries, and sustained-release treatment platforms. Future needs in the area of sustained-release therapy include a non-prostaglandin drug delivery platform and longer-term treatments that do not require surgical reintervention.