First-line treatment for glaucoma is typically pharmacologic and aimed at lowering intraocular pressure, which is the only modifiable risk factor to date. However, successful treatment with traditional topical glaucoma medications may be limited by their well-known barriers of adverse effects and poor patient adherence to drop instillation. Tune in to hear Dr. Qi Cui and Dr. Davinder Grover discuss the novel pharmacological therapies and minimally invasive glaucoma surgery procedures that can lower treatment burden and increase compliance.
Advances in Glaucoma Treatment: Novel Topical Therapies
Advances in Glaucoma Treatment: Novel Topical Therapies
Welcome to CME on ReachMD. This episode is part of our MinuteCME curriculum.
Prior to beginning the activity, please be sure to review the faculty and commercial support disclosure statements as well as the learning objectives.
This is CME on ReachMD, and I’m Dr. Qi Cui. Let’s take a look at some of the novel agents for the treatment of early- to moderate-stage glaucoma and how they fit into clinical practice.
Omidenepag isopropyl ophthalmic solution is approved for use at a concentration of 0.002% to treat glaucoma and ocular hypertension. It is to be administered topically once daily in the evening to the affected eyes. Upon corneal penetration, omidenepag isopropyl is hydrolyzed to its active metabolite which acts as a selective prostaglandin E2 receptor agonist. The prostaglandin E2 receptor is a transmembrane G protein-coupled receptor that increases cyclic AMP levels to facilitate aqueous humor outflow through both the trabecular and the uveoscleral pathways.
An advantage of omidenepag isopropyl over some other glaucoma medications is its longer duration of action, requiring less frequent administration. In clinical trial, omidenepag demonstrated comparable IOP [intraocular pressure]-lowering efficacy to latanoprost 0.005% at 4 weeks and may be efficacious in non or poor responders to latanoprost. Omidenepag may also exhibit fewer long-term prostaglandin-associated periorbitopathy, such as fat atrophy and hyperpigmentation compared to prostaglandin F receptor agonists.
Netarsudil/latanoprost is a fixed-dose combination medication approved for lower intraocular pressure in patients with open-angle glaucoma and ocular hypertension. It is to be administered topically once daily in the evening to the affected eyes. Netarsudil is a rho-kinase inhibitor that is thought to increase aqueous humor outflow through the conventional pathways, while also decreasing episcleral venous pressure and oxidative stress. Its intraocular pressure-lowering effects have been shown to increase with the addition of the selective prostaglandin F receptor agonist latanoprost.
In a pooled efficacy analysis of two phase 3 superiority studies comparing netarsudil/latanoprost to monotherapies of either netarsudil or latanoprost, combination therapy was shown to produce IOP lowering that was statistically in excess of netarsudil and latanoprost monotherapy. As is the case with omidenepag isopropyl, an advantage of netarsudil/latanoprost over other glaucoma medications is its longer duration of action requiring less frequent administration. Conjunctival hyperemia in excess of observed with latanoprost is the most commonly reported adverse effect of netarsudil administration. Other notable side effects include subconjunctival hemorrhage, corneal verticillata, tearing, instillation site pain, erythema, and eyelid erythema.
A good tip to keep in mind might be patients who might benefit from omidenepag would be one who responds to prostaglandin analogs but is experiencing prostaglandin-associated periorbitopathy. Now the patients who might benefit from netarsudil/latanoprost would be someone who is not reaching goal IOP on a single agent but wants to limit their medication administration frequency to once a day.
Brimonidine tartrate ophthalmic suspension, formulated using a proprietary resin microparticle complex drug delivery system is pending a decision by the US FDA for once-daily dosing for the treatment of open-angle glaucoma and ocular hypertension. A phase 3 equivalence trial compared once daily brimonidine tartrate suspension to brimonidine tartrate 0.1%, administered 3 times a day, met its prespecified primary endpoint of noninferiority at 12 weeks.
In summary, all 3 agents benefit from once-daily dosing but function through different mechanisms of action. Thank you for tuning in, but my time is up. This has been CME on ReachMD.
You have been listening to CME on ReachMD. This activity is provided in partnership with the National Eye Institute of the National Institutes of Health, of the U.S. Department of Health and Human Services along with Prova Education, and is part of our MinuteCME curriculum.
To receive your free CME credit, or to download this activity, go to ReachMD.com/Prova. Thank you for listening.
In accordance with the ACCME Standards for Integrity and Independence, Global Learning Collaborative (GLC) requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any ineligible company. GLC mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.
Qi Cui, MD, PhD
Assistant Professor of Ophthalmology
University of Pennsylvania
No relevant relationships reported.
Davinder S. Grover, MD, MPH
Glaucoma Specialist, Ophthalmologist
Glaucoma Associates of Texas
Fort Worth, TX
Advisory Board: CATS Tonometer, iSTAR Medical, Sanoculis, Versant Health
Consulting fees: Allergan, New World Medical, Nova Eye Medical, Olleyes, Reichert, Sanoculis
Research: Allergan, New World Medical
- Stephen Chavez has nothing to disclose.
- Cindy Davidson has nothing to disclose.
- Elizabeth Lurwick had nothing to disclose.
- Andrea Mathis has nothing to disclose.
- Colleen Resnick has nothing to disclose.
- Robert Schneider has nothing to disclose.
- Stephanie Wenick, MPhil, has nothing to disclose.
After participating in this educational activity, participants should be better able to:
- Describe topical therapies and sustained-release formulations of antiglaucoma medications that may improve patient adherence
- Recognize minimally invasive glaucoma surgery (MIGS) uses and indications
- Evaluate clinical data of recently approved topical therapies, sustained-release formulations of antiglaucoma medications, and MIGS for patients with early- to moderate-stage glaucoma
- Implement strategies to individualize therapy for patients with early- to moderate-stage glaucoma
This activity is designed to meet the educational needs of ophthalmologists and optometrists.
In support of improving patient care, Global Learning Collaborative (GLC) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
Global Learning Collaborative (GLC) designates this enduring activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Global Learning Collaborative (GLC) designates this activity for 1 nursing contact hour. Nurses should claim only the credit commensurate with the extent of their participation in the activity.
Prova Education designs and executes continuing education founded on evidence-based medicine, clinical need, gap analysis, learner feedback, and more. Our mission is to serve as an inventive and relevant resource for clinical content and educational interventions across a broad spectrum of specialties.
Prova Education's methodology demonstrates a commitment to continuing medical education and the innovative assessment of its effects. Our goal is clear—to develop and deliver the very best education in the most impactful manner and to verify its results with progressive outcomes research.
This activity is supported by independent educational grants from AbbVie, Inc and Alcon.
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of GLC and Prova Education. This presentation is not intended to define an exclusive course of patient management; the participant should use his/her clinical judgment, knowledge, experience, and diagnostic skills in applying or adopting for professional use any of the information provided herein. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Links to other sites may be provided as additional sources of information. Once you elect to link to a site outside of Prova Education you are subject to the terms and conditions of use, including copyright and licensing restriction, of that site.
Reproduction of this material is not permitted without written permission from the copyright owner.
Our site requires a computer, tablet, or mobile device and a connection to the Internet. For best results, a high-speed Internet connection is recommended (DSL/Cable/Fibre). We also recommend using the latest version of your favorite browser to ensure compliance with W3C standards, such as Chrome, Safari, Firefox, or Microsoft Edge.