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Research continues on different pathways for glaucoma drugs
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DANA POINT, Calif. — Glaucoma drugs that may offer neuroprotection or more effectively decrease trabecular outflow resistance are under investigation and may someday be added to the glaucoma specialist’s arsenal, according to a speaker here.
Steven M. Podos, chairman of ophthalmology at New York’s Mt. Sinai Hospital, reviewed the drugs currently available for glaucoma treatment and looked ahead at some of the drugs in development. He delivered the Irving Leopold lecture at the Ocular Drug and Surgical Therapy Update meeting here.
Among the new pharmacologic strategies for glaucoma treatment under investigation are glutamate antagonists, calcium channel blockers, nitric oxide synthase inhibitors, free radical scavengers, apoptosis inhibitors, neurotrophins and autoimmune modulators, Dr. Podos said. Myocillin and optineurin gene-related strategies are also being explored, he said.
Dr. Podos and colleagues are currently investigating iso-prostaglandins in monkeys and the effects of 0.1% 9-iso PGE2 in the aqueous humor, he told attendees.
Other pharmacologic possibilities to alter the resistance of the trabecular meshwork include cytoskeleton proteins and endothelial leukocyte adhesion molecule-1, which is related to the stickiness of cells, he said.
Dr. Podos said the currently available ocular hypotensive agents include beta-blockers, alpha2 adrenergic agonists, topical carbonic anhydrase inhibitors and the prostaglandin-like drugs. This latter class includes latanoprost, unoprostone isopropyl, travoprost and bimatoprost.
Dr. Podos noted that key studies in the literature show latanoprost to be more effective at lowering IOP than previously available drugs including timolol and dorzolamide.
Latanoprost is not without side effects, however, he said. Iris hyperpigmentation, conjunctival hyperemia, punctate epithelial erosions, growth of lashes and hair, cystoid macular edema, uveitis and activation of herpes simplex keratitis have been reported, Dr. Podos said.
Unoprostone is a prostaglandin based drug, but its effect is milder than latanoprost, Dr. Podos said. It is administered twice daily as opposed to once for latanoprost, he said.
Two newer prostaglandins are travoprost and bimatoprost, Dr. Podos said. Both travoprost and bimatoprost have been shown to be more efficacious than timolol, Dr. Podos said. One study by Noecker and colleagues showed that bimatoprost was superior to latanoprost in lowering of IOP, but another study found no difference among latanoprost, bimatoprost and travoprost, he said.