Topical treatment of glaucoma: established and emerging pharmacology

• Published in: Expert opinion on pharmacotherapy Vol. 18; no. 9; p. 885
• Main Authors: Dikopf, Mark S, Vajaranant, Thasarat S, Edward, Deepak P
• Format: Journal Article
• Language: English
• Published: England 13-06-2017
• Subjects: Administration, Topical; Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - therapeutic use; Animals; Carbonic Anhydrase Inhibitors - administration & dosage; Carbonic Anhydrase Inhibitors - therapeutic use; Clinical Trials as Topic; Glaucoma - drug therapy; Glaucoma - metabolism; Humans; Intraocular Pressure - drug effects; Muscarinic Agonists - administration & dosage; Muscarinic Agonists - therapeutic use; Optic Nerve - drug effects; Optic Nerve Diseases - drug therapy; Optic Nerve Diseases - metabolism; Prostaglandins - administration & dosage; Prostaglandins - therapeutic use; Retinal Ganglion Cells - drug effects; Sympathomimetics - administration & dosage; Sympathomimetics - therapeutic use; Trabecular Meshwork - drug effects; nitric oxide; primary open angle glaucoma; uveoscleral outflow; neuroprotection; norepinephrine transporter inhibitor; Adenosine receptor; RHO-associated protein kinase inhibitor; ribonucleic acid interference; trabecular meshwork
• ISSN: 1744-7666
• DOI: 10.1080/14656566.2017.1328498

Glaucoma is a collection of optic neuropathies consisting of retinal ganglion cell death and corresponding visual field loss. Glaucoma is the leading cause of irreversible vision loss worldwide and is forecasted to precipitously increase in prevalence in the coming decades. Current treatment options aim to lower intraocular pressure (IOP) via topical or oral therapy, laser treatment to the trabecular meshwork or ciliary body, and incisional surgery. Despite increasing use of trabecular laser therapy, topical therapy remains first-line in the treatment of most forms of glaucoma. Areas covered: Novel glaucoma therapies are a long-standing focus of investigational study. More than two decades have passed since the last United States Food and Drug Administration (FDA) approval of a topical glaucoma drug. Here, the authors review established topical glaucoma drops as well as those currently in FDA phase 2 and 3 clinical trial, nearing clinical use. Expert opinion: Current investigational glaucoma drugs lower IOP, mainly through enhanced trabecular meshwork outflow. Although few emerging therapies show evidence of retinal ganglion cell and optic nerve neuroprotection in animal models, emerging drugs are focused on lowering IOP, similar to established medicines.