Q: Are there any new developments for the treatment of glaucoma?
A: Glaucoma is an eye disease that affects the optic nerve, which transmits images from the eye to the brain. Glaucoma affects more than 3 million people in the United States and this number is expected to double by 2050. It is typically associated with high intraocular pressure (IOP) and has few or no early symptoms. If glaucoma is not treated effectively by lowering IOP with medication eye drops, laser therapy, or surgery, patients can suffer from permanent vision loss.
Today is an exciting time for the management of glaucoma as new treatments are evolving. In 2017, two new classes of glaucoma drops were released: Vyzulta and Rhopressa, the first major breakthrough since 1998 for topical medication. Vyzulta, a dual-action once-daily drop, helps lower IOP by increasing the drainage of fluid from the eye. It is a modification of the current group of prostaglandin analogs. Vyzulta has been FDA-approved for the reduction of IOP in open-angle glaucoma and ocular hypertension. Rhopressa is a new class of drugs used to treat glaucoma called rho kinase inhibitors. Used once daily, it also lowers IOP by increasing the outflow of drainage from the eye. In addition to being approved for open-angle glaucoma and ocular hypertension, Rhopressa can also be used for the treatment of normal or low-tension glaucoma.
When eye drops and laser therapies do not adequately lower IOP, surgery may be an option. In addition to traditional glaucoma surgeries such as a trabeculectomy or tube shunt placement, there is now a variety of approved MIGS, Minimally-Invasive Glaucoma Surgeries, available for use in the United States. The goal of MIGS is to reduce IOP by enhancing the eye’s internal drainage system. Some MIGS can be performed as standalone procedures while others are done along with cataract surgery in patients with visually significant cataracts and mild to moderate glaucoma.
MIGS is typically performed through microscopic incisions in the eye with minimal tissue trauma. This type of surgery offers a high safety profile, quicker recovery time in many cases, and there is less risk of complications. MIGS is appropriate for patients with mild to moderate glaucoma. While MIGS will not replace or eliminate traditional glaucoma surgery, it has greatly decreased the number of patients who require more invasive surgeries to control IOP.
While glaucoma cannot be cured, it can be treated and managed with eye drops and/or special surgeries so that both the IOP and flow of eye fluid are at appropriate levels. Now, more than ever, your eye doctor has more tools to treat glaucoma. Appropriate treatment for glaucoma depends on the nature and stage of your glaucoma. Work closely with your eye doctor to determine which treatment(s) are best for you.