A LOOK AT DEVICES AND A MEDICATION THAT COULD THWART THE SILENT THIEF

THANKS TO advances in the device and pharmaceutical realms, we can identify glaucoma early and prescribe an array of treatments designed to prevent vision loss from this progressive disease. And guess what? More are on the way!

DEVICES

Two developments are of note:

1. Cerebral spinal fluid (CSF) pressure diagnostic devices. Researchers are working to create diagnostic technologies that can measure CSF pressure non-invasively. (In fact, more than 90 studies are available on this topic.) The reason: An imbalance between CSF pressure and IOP around the lamina cribrosa is believed to play a role in the development and progression of glaucoma. Therefore, it is believed that having CSF data could facilitate therapeutic plans.
2. IOP-lowering eyewear. Two are in the pipeline: one from Bionode and one from Equinox.

The device from Bionode, a Purdue University-affiliated start-up company, is a wearable neuro-modulation device comprised of a modified “off-the-shelf” contact lens and pair of spectacles.

The contact lens has a thin, gold insert around its edge to act as a biocompatible electrode. The gold insert receives an electromagnetic field transmitted from the spectacles to convert the field into a current. The current stimulates the muscles around Schlemm’s canal to reduce resistance and decrease IOP. (See video at http://bit.ly/2yUPHTn .) Bionode is also looking at using the spectacles alone, as they are modified with a coil which produces a magnetic field that generates a current. The current, like the contact lens, stimulates the muscles around Schlemm’s canal to reduce resistance and decrease IOP.

Bionode has a working prototype of the platform and is currently seeking funds for a human clinical trial.

The device from Equinox is based on the CSF imbalance belief. It is comprised of a pair of goggles attached to a pump, which enables one to control and change the pressure inside the goggles and, thus, the IOP inside the eye. (See video at http://bit.ly/2CBcm9w .)

The benefit of these technologies is that they are based on a non-pharmaceutical approach, which some patients prefer.

MEDICATIONS

With the recent FDA approvals of latanoprostene bunod 0.024% (Vyzulta, Bausch + Lomb) and netarsudil 0.02% (Rhopressa, Aerie Pharmaceuticals) in November and December, respectively, the only glaucoma medication in the pipeline, as we go to press, is netarsudil 0.02% latanoprost 0.005% (Roclatan, Aerie Pharmaceuticals).

This fixed combination therapy enhances trabecular meshwork outflow, increases uveoscleral outflow, decreases aqueous production and reduces episcleral venous pressure.

Aerie Pharmaceutical’s Chairman and CEO Vicente Anido, Jr., Ph.D., says the company “remains on track” to file an NDA for Roclatan in the second quarter of 2018, according to a company-issued press release on the FDA approval of Rhopressa. OM

DR. SCHWEITZER specializes in advanced glaucoma, refractive surgical clinical care and anterior segment pathology at Vance Thompson Vision. He is a prolific writer on glaucoma, anterior segement pathology and more, Also, he is a consultant for Alcon, Allergan, Bausch + Lomb, Bio-Tissue, Reichert and TearScience. Email him at justin.schweitzer@vancethompsonvision.com.