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Glaucoma Pipeline
A View Into Ongoing Innovation
Iqbal Ike K. Ahmed, MD, FRCSC
With new devices recently coming to market, and others in late stages of development, the options are expanding for specialists to intervene across the spectrum of glaucoma severity and subtype with interventions that do not rely on patients' compliance. Owing to their potential to spare or reduce medication use and positively impact quality of life, procedural options also challenge the clinician to rethink the definition of a successful outcome.
Select a number to view the surgical developments in process.
1
Drainage to Ocular Surface
- Sollevio (Alevio)
Investigational
- Beacon Aqueous Microshunt (MicroOptx)
Investigational
2
AQUEOUS OUTFLOW AT MESHWORK
- Trabectome (MicroSurgical Technology)
- KDB Glide (New World Medical)
- Gonioscopy-Assisted Transluminal Trabeculotomy (GAAT)
- Therapeutic Ultrasound for Glaucoma (TUG, EyeSonix)
Investigational
- Argon Laser (488/514 nm [Argon Laser] or 532 nm [Nd:YAG])
- Selective Laser (532 nm)
- Pattern Scanning (577 nm – Topcon)
- Micropulse Diode Laser / ab externo Micropulse (810 nm – Iridex)
- Elios (308 nm Xenon Chloride Excimer Laser - Elios Vision)
- Femtosecond (ViaLase)
Laser Trabeculoplasty (laser wavelength):
3
Schlemm Canal
- iStent / iStent Inject/ iStent Inject W (Glaukos)
- Hydrus (Ivantis)
- iTrack (Nova Eye Medical)
- OMNI Surgical System (Sight Sciences)
- iStent Infinite (Glaukos)
Investigational
- Streamline Surgical System (New World Medical)
Investigational
- iPrime Viscodelivery System (Glaukos)
Investigational
4
Aqueous Production
- Transscleral Cyclophotocoagulation (TSCPC, Iridex)
- Micropulse Diode Laser Transscleral Cyclophotocoagulation (MP-TSCPC, Iridex)
- Endocyclophotocoagulation (ECP, BVI Medical)
- High-Intensity Focused Ultrasound (HIFU - EyeOP1, EYE TECH CARE)
Investigational
5
Supraciliary Drainage
- iStent Supra (Glaukos)
Investigational
- MINIject (iStar Medical)
Investigational
6
Subconjunctival
Filtering Bleb Procedures
- Baerveldt Glaucoma Implant (Johnson & Johnson Vision)
- Ahmed Glaucoma Valve (New World Medical)
- Ahmed ClearPath (New World Medical)
- Molteno3 (Molteno Ophthalmic)
- PAUL Implant (Advanced Ophthalmic Innovations)
US Investigational
- eyeWatch (Rheon)
US Investigational
- Ex-PRESS (Alcon) external
- XEN45 / XEN63 Gel Stent (Allergan, an AbbVie company) internal/external
- PreserFlo MicroShunt (Santen) external
US Investigational
- Minimally Invasive Micro Sclerostomy (MIMS, Sanoculis)
US Investigational
TRADITIONAL INCISIONAL SURGERIES
Trabeculectomy
Aqueous Drainage Devices
MINIMALLY INVASIVE BLEB SURGERIES
John R. Samples, MD
While targeting IOP as the only known modifiable risk factor for glaucomatous progression remains a viable strategy, there is cautious optimism regarding new therapeutics with truly novel targets. An era in which we seek to modify the glaucoma disease process, treat its root causes, and/or reverse damage may be closer than we think.
Select a symbol to view the pharmaceutical developments in process.
Shape Legend
-
Uveoscleral Outflow
-
Aqueous Outflow: The Canal and Beyond
-
Aqueous Production
-
Aqueous Outflow at Meshwork
Color Legend
-
Current drug classes
-
Novel/Investigational therapy approaches
-
Prostaglandins
-
Nitric Oxide-Donating Compounds
-
Rho Kinase Inhibitors
-
Omidenepag Isopropyl (DE-117, Santen)
PIPELINE
-
NCX 470 (Nicox)
PIPELINE
-
Muscarinic Agonists (Miotics)
-
Beta-Blockers
-
Alpha-Agonists
-
Carbonic Anhydrase Inhibitors
-
ATP Potassium Channel Modulators
PIPELINE
-
Autotaxin-Lysophosphatidic Acid
PIPELINE
COMBINATION MEDICATIONS
-
Rocklatan (Netarsudil and Latanoprost; Aerie)
-
Cosopt / Cosopt PF (Dorzolamide HCl & Timolol Maleate; Akorn)
-
Combigan (Brimonidine Tartrate & Timolol Maleate; Allergan)
-
Simbrinza (Brinzolamide & Brimonidine tartrate; Novartis)
(Advantages ↑compliance, adherence ↓preservative, copay
Extended Duration Options
- • DURYSTA (Bimatoprost SR; Allergan, an AbbVie company)
- • ENV515 (Aerie)
PIPELINE
- • iDose (Glaukos)
PIPELINE
INTRACAMERAL DEVICES
- • Bimatoprost Ocular Ring (Allergan, an AbbVie company)
PIPELINE
External Ocular Insert
- • Evolute (Mati Therapeutics)
PIPELINE
PUNCTAL PLUGS
Potential Candidates in Neuroprotection
- • Brimonidine
SUSTAIN RETINA GLIAL CELL VIABILITY
Promote non-amyloidogenic beta pathway
- • Memantine
- • Brimonidine
Decrease glutamate-induced excitotoxicity
- • Ginkgo biloba extract
- • Omega 3
Suppress oxidative stress
- • Coenzyme Q10 and Vitamin E
- • Ginkgo biloba extract
Inhibit mitochondrial dysfunction
- • Valproic acid
Stimulate cell survival pathway
- • Brain-Derived Neurotrophic Factor, Nerve Growth Factor, Ciliary Neurotrophic Factor
- • Mesenchymal stem cells
- • Umbilical cord serum
PROMOTE REGENERATION
Replace neurotrophin
- • Citicoline
Stimulate non-glutamatergic neurotransmitter synthesis
- • Phenytoin
NEUROENHANCEMENT
Block sodium channel
* While this image is generally representative of the TM structure as it is currently understood, it cannot properly demonstrate that aqueous outflow is pulsatile and segmental based on the non-uniform appearance of distal outflow structures around the 360 TM.
Addressing the Etiology of High IOP
TREATING THE CAUSES OF GLAUCOMA
Several lines of research suggest the potential to address the initiating events leading to pressure elevation and damage to the optic nerve. Investigations are ongoing in two broad areas:
1. Reversing structural/functional damage in the TM.
2. Reversing Schlemm canal/juxtacanalicular tissue stiffening.
Within the context of disease modification, there is also significant interest in strategies that address outflow resistance in the ostia/collector channels/episcleral veins.