Eyeworld

FEBRUARY 2025 | EYEWORLD BONUS ISSUE | 25 G Contact Bacharach: jb@northbayeye.com Brubaker: jbrubaker@saceye.com References 1. Rhee DJ, et al. Primary practice patterns for the initial manage- ment of open angle glaucoma. J Glaucoma. 2024;33:671–678. 2. Gazzard G, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre ran- domised controlled trial. Lancet. 2019;393:1505–1516. 3. Lin MM, et al. Netarsudil's effect in eyes with a history of selective laser trabeculoplas- ty. Ophthalmol Glaucoma. 2020;3:306–308. Relevant disclosures Bacharach: Alcon, AbbVie, Bausch + Lomb, Glaukos, Harrow, Nicox, Ocular Thera- peutix, PolyActiva, Santen, Sun Ophthalmics, TearClear, Thea Brubaker: AbbVie, Alcon, Glaukos Brubaker, though he does think, with the inter- ventional glaucoma mindset, ophthalmologists should be able to reduce patients' drop burden. Dr. Bacharach discussed the benefit of following a customized algorithm for glauco- ma patients, something that is becoming more refined as some drops have data demonstrating that they work well with certain procedures. One example was a retrospective cohort study published in 2020 that found patients who began using netarsudil 3.0±2.9 years after SLT had additional IOP lowering. 3 "The point is, it shouldn't be a cookbook. You should think about how to mix and match today, what pharmacotherapy makes sense with which procedures," Dr. Bacharach said. "With IRIS Registry data and big data available to us, we can go back and figure out what is the best outcome for a patient based on data." Dr. Bacharach also said ophthalmologists could consider using samples from industry partners to do a monotherapeutic trial with their patients, keeping them on the old drop in one eye and a sample drop in the other, to see if you they get additional efficacy over baseline. "Look at the literature, use your own clin- ical acumen," Dr. Bacharach said, noting real- world studies with different medications are available, "and get feedback from the patients on tolerability." New and exciting drops In recent years, Dr. Brubaker said there have been "little splashes in the pan" in the world of new glaucoma pharmaceuticals, with preserva- tive-free options being the most exciting to him. "There are some products that are on the horizon … that are looking at rho-kinase inhib- itors that are a little less potent as far as side effects are concerned," he said. "My hope is that we can find some rho-kinase inhibitors that are just as effective but are maybe less inflammato- ry and cause less red eyes. Those are fairly early as far as Phase 2 and Phase 1 trials. It will be some time before those arrive. There is also an adenosine receptor agonist in clinical trials." Dr. Bacharach said for patients who have ocular surface disease and experience drop toxicity, he's looking at IYUZEH (latanoprost ophthalmic solution, 0.005%, Thea Pharma), which received FDA approval in 2022. He also said that XELPROS (latanoprost ophthalmic emulsion, 0.005%, Sun Ophthalmics) is an alternatively preserved drop (potassium sorbate as the preservative) coming back to market in 2025. Many new drops and those in the pipeline target different mechanisms of action or preser- vative-free alternatives. Dr. Bacharach men- tioned omidenepag isopropyl 0.002% (OMLONTI, Santen Pharmaceutical), which is an EP2 agonist approved by the FDA in 2022, NCX 470 (Nicox), a nitric oxide-donating bimatoprost in Phase 3 development, and QLS-111 (Qlaris), a ATP-sensitive potassium channel modulator platform, in Phase 2 trials. Final points Taking away all drops and treating only with interventions would be hard, according to Dr. Dr. Bacharach's minimal instillation drop strategy (MIDS); OD: post-streamlining, post-SLT on q daily monotherapy; OS: still on multiple generic preserved agents (five drop applications per day) Source: Jason Bacharach, MD Leon Herndon Jr., MD, EyeWorld Glaucoma Editorial Board member, shared his thoughts on interventional glaucoma: "We know that patient compliance with glaucoma medications is suboptimal. It is a real advance that we are now able to offer safer alternatives to patients that take compliance concerns out of their hands." INTERVENTIONAL GL AUCOMA

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