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Injectable glaucoma drug may lead new treatment paradigm
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WAIKOLOA, Hawaii – The injectable anecortave acetate may hold the potential to usher in a new glaucoma treatment paradigm by greatly reducing issues with patient compliance, according to a speaker here at Hawaiian Eye 2008.
OSN Glaucoma Section Member Alan L. Robin, MD, described obstacles to patient adherence to therapeutic regimens.
He said the glaucoma community should evaluate three issues: the adequacy of present therapies, whether or not patients adhere to those therapies and whether or not they demonstrate strong performance.
Dr. Robin said that an investigational new modality — anterior juxtascleral delivery of anecortave acetate — could offer an effective alternative to drops to combat the adherence and persistency problem.
“How many of you actually watch your patients put drops in their eyes and take the time to teach them to do it?” he asked. “It’s not like, ‘Take two aspirins and get plenty of rest.’ There is more to it than that.” About one-half to two-thirds of glaucoma patients need more than one therapy after 1 year, leading to the possibility that they will burn out, he said.
“We need a medication that works better than once a day, with fewer side effects than prostaglandin analogues, which are good drugs. We need a better than 30% decrease in IOP, something that’s additive to a prostaglandin and something that people can deliver,” he said.
Dr. Robin said he and his colleagues have evaluated 140 patients who use various kinds of glaucoma drops. Overall, they found that roughly three-quarters of patients “don’t get the drops out of the bottles into their eyes successfully without spillage or contamination.”
“A lot of people have problems administering [drops] themselves and have to be dependent on others,” he said.
Anecortave acetate, an injectable drug under development by Alcon, is promising because it does not have anti-inflammatory effects, does not increase IOP in uveitis patients, does not raise IOP and has not been shown to cause cataracts. It has low solubility and its IOP lowering effects can last for months.
Injected into the sub-Tenon’s space, anecortave acetate diffuses within a few hours and “seems to migrate to the area around the trabecular meshwork.” The modality represents a “potential paradigm shift in the way we treat glaucoma,” he said.
“It may obviate problems in how people take drops. It may be an exciting new venue for formulations of medications to help prevent blindness” in glaucoma patients, Dr. Robin said.
Customized surgical approaches benefit glaucoma patients with cataracts
Advances in procedures and technology have greatly expanded surgical options for glaucoma patients with cataract, according to a speaker.
Robert J. Noecker, MD, MBA, spoke about various approaches to these challenging cases.
“This used to be a boring talk … but things have gotten so much more interesting,” thanks to the rapid evolution of both cataract and glaucoma surgical technology, Dr. Noecker said.
In general, he said, taking out the cataract in a glaucoma patient “is a very good thing to do.” Removing the cataract can improve the visual field and facilitate imaging by eliminating the opacification, he said.
Dr. Noecker recommended topical clear cornea cataract surgery because it minimizes contact with the conjunctiva, reduces the possibility of scarring and preserves the possibility for future surgery.
Dr. Noecker said he prefers to perform the surgeries separately rather than in a combined procedure to better control astigmatism, IOL positioning, degree of inflammation and visual recovery.
If a combined procedure is chosen, however, numerous glaucoma techniques and technologies, including endoscopic cyclophotocoagulation, canaloplasty, the ExPress mini shunt (Optonol), the Baerveldt implant (Advanced Medical Optics) and the Trabectome (NeoMedix), can work well in conjunction with phacoemulsification, he said.
“The nice thing is that we can customize now. We have all these options, and we’re moving away from the old gold standard,” he said.
This article was originally featured in Ocular Surgery News, a SLACK Incorporated publication.
For more information:
- Alan L. Robin, MD, a PCON Editorial Board member, can be reached at Johns Hopkins University, 6115 Falls Rd., Suite 333, Baltimore, MD 21209-2226; (410) 377-2422; fax: (410) 377-7960; e-mail: Glaucomaexpert@cs.com.
- Robert J. Noecker, MD, MBA, can be reached at the University of Pittsburgh Medical Center, Eye and Ear Institute, 203 Lothrop St., 8th Floor, Pittsburgh, PA 15213; (412) 647-2200; fax: (412) 647-5119; e-mail: noeckerrj@upmc.edu.