Eyeworld

World view Saving sight M edical treatment for glaucoma saves sight. Patients come to my office every day who continue to have vision only because they have taken their eye drops for many years. These medications are a triumph of innovation and a tribute to the commitment of pharmaceuti- cal companies to make the investments necessary to bring these breakthrough products to market. But there are still challenges and unmet needs. This month, we focus on key issues of medical therapy and provide an update on new developments. There are many new products in the pipeline. The status of these exciting com- pounds is reviewed by Jason Bacharach, MD, Jacob Brubaker, MD, Tony Realini, MD, and Gary Novack, PhD. The ups and downs of Rhopressa, one of the most impressive new formulations, shows the complexity and high risk of innovation in glaucoma medical treatments. I was involved in a start-up glaucoma device company with an executive who at his previous job had been instrumental in bringing to market one of our most important glaucoma eye drops. He said there was serious consider- ation given to not proceeding with its launch because there was such uncer- tainty about its ultimate revenue. The company eventually did go forward with the launch, and it has become our most popular—and biggest selling— medication. I was shocked that there could ever have been doubt about the commercial success of this medication, but it demonstrates how much easier it is to evaluate drug development decisions in retrospect. One gaping hole in our treatment success is compliance. This is reviewed by Thomas Harbin, MD, Robert Feldman, MD, and Michael Boland, MD. The intransigence of compliance issues highlights the need for therapies with extended durations. This topic is reviewed by Rick Lewis, MD, Gary Novack, PhD, and Malik Kahook, MD. Extended release seems an obvi- ous enhancement to therapy, but it has been an elusive goal. One of the major advantages of extended release—that is sometimes overlooked—is that the ambient level of medication is much lower than the intense initial concentration administered through an eye drop. The lower concentration level addresses other major problems of drop therapy—intolerance and side effects. Ocular irritation is dramatically reduced by a low level of drug, deliv- ered consistently over a period of months rather than hours. This would be a major breakthrough. While we are waiting for new therapies, the key decisions are how to use the medications that are currently available. This is reviewed by Dana Wallace, MD, Davinder Grover, MD, and Parag Parekh, MD. We have many more choices than ever before, and this brings new challenges as we try to tailor therapies to the patient. Laser trabeculoplasty is another option that has an important role in glaucoma treatment, but doctors have different thoughts about when to recommend it. Glaucoma patients—and we who treat them—are grateful for the medi- cations we have, and our therapies have never been better. Our patients who are compliant are doing quite well—in many cases taking just one drop per day as they stave off a blinding, incurable disease. But this is not enough. We need to create therapies that are safer, last months rather than hours, and have fewer side effects. Many great innovations are on the way, and these new treatment modalities will forever change how we medically treat glaucoma. EW Reay Brown, MD, glaucoma editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S November 2015 Volume 20 • No. 11 Publisher Donald R. Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Staff Writer Ellen Stodola ellen@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org 703-383-5702 Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Vanessa Caceres Bradenton, Fla. Michelle Dalton Reading, Pa. Matt Young Malaysia Rich Daly Arlington, Va. Senior Contributing Writer Maxine Lipner Nyack, N.Y. Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Paul Zelin paul@eyeworld.org 703-383-5729 Classified Sales Cathy Stern cathy@eyeworld.org 703-383-5702 EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org 703-591-2220 ASCRS Publisher: EyeWorld (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. Printed in the U.S. Editorial Offices: EyeWorld News Service, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. Advertising Offices: ASCRSMedia, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. 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