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    Tomorrowland: What the future holds in glaucoma therapies

    San Diego—The present method of lowering IOP as a means of preventing optic neuropathy is expanding beyond prostaglandin analogues and beta blockers to include novel therapeutics, such as Rho kinase (ROCK) inhibitors, the adenosine class of drugs, and nitric oxide added to prostaglandins, said John R. Samples, MD, Olympia, WA.

    “Glaucoma therapy is on the cusp of a revolution,” he said—with three or more drugs in “truly new classes,” new drug delivery devices that will obviate patient compliance, and surgical devices and techniques that will prove “more effective with a lower morbidity” than what is currently available.

    Related: Can Schlemm’s canal surgery be glaucoma’s Holy Grail?

    Two ROCK inhibitors are well on their way—Aerie Pharmaceuticals is conducting two phase III studies on the inhibitors with some results anticipated this year. Kowa has a ROCK inhibitor in phase III studies in Japan. Most other new therapies are only in phase II or phase IIa, he said.

    “But soon we’re going to be able to measure the actual loss of retinal ganglion cells to define glaucoma,” he said during Glaucoma Day at the 2015 meeting of the American Society of Cataract and Refractive Surgery.

    Clinicians will be able to treat the specific underlying molecular abnormality discovered with lab and genetic testing, he said.

    “We will be able to confer health on the meshwork and the nerve,” Dr. Samples said, with a combination of protective agents and stem cell therapies.

    Bausch + Lomb is developing a nitric oxide-donating latanoprost that is in phase 3, and Santen and Ono are developing prostaglandins that are also likely incompatible with today’s medical therapies, he said.

    Next: 'No gaurantee'

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