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Studies show genetics may predict IOP-lowering drug response
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WAILEA, Hawaii — A number of studies have shown that genetics are able to predict the IOP-lowering medication response of individual patients, according to a presenter here.
 M. Elizabeth Fini |
At Hawaiian Eye 2009, M. Elizabeth Fini, PhD, reported on several studies, including a pilot study she and her colleagues are currently conducting, that show a genetic link to patient response to IOP-lowering medications.
"The published studies that answer this question have examined response to beta-adrenergic receptor antagonists and prostaglandin analogs," Dr. Fini said. "Preliminary efforts have also investigated the phenomenon of increased IOP following injection of intravitreal triamcinolone."
In 2003, Camras et al published one of the first studies showing an individual response to glaucoma medications, she said. In 2005, Schwartz et al identified a mechanism for individual response to betaxolol, and in 2007, Sakurai et al identified a mechanism for individual response to latanoprost.
"These variants may also influence natural IOP and thus may affect risk for glaucoma," Dr. Fini said.
It has been shown that 40% of patients with retinal diseases treated with intravitreal triamcinolone experienced an IOP spike, she said. In a pilot study using the Affymetrix Mapping 500K Array Set, Dr. Fini and colleagues tested the change of IOP in eyes treated with intravitreal triamcinolone. In 56 eyes of 52 patients, Dr. Fini and colleagues found that 48 different single nucleotide polymorphisms within 33 genes correlated (P < .001).
While the small study needs to be replicated, "the [single nucleotide polymorphisms] identified in this study may lead us to new outflow mechanisms and may further serve as drug targets for lowering intraocular pressure," Dr. Fini said.
Dr. Fini’s presentation highlights a very exciting new area in medicine and its potential application in glaucoma. Personalized medicine identifies the most appropriate treatment determined by the patient’s own genetic make-up. In the future – although not today – we will be able to tailor the choice of therapy to that which we know will work best for a given individual.
– Joel S. Schuman, MD, FACS
OSN Glaucoma Board Member