79
EW GLAUCOMA
October 2016
surgery, where we're taking advan-
tage of bypassing the trabecular
meshwork and taking advantage of
the natural outflow pathway, drugs
that enhance outflow through the
physiologic way, the natural way,
may be preferred over drugs that do
other things like undo legal outflow
or decrease the production of aque-
ous humor. I think the conversation
is going to move away from just
pressure reduction to mechanisms
of action, and if we start to think
about combining laser trabeculoplas-
ty with MIGS, we may want drugs
that are going to facilitate fluid
movement going through the eye's
natural outflow pathway." EW
Editors' note: Dr. Radcliffe has finan-
cial interests with Bausch + Lomb. Dr.
Robin has no financial interests related
to his comments. Dr. Vold has financial
interests with Aerie Pharmaceuticals
and Bausch + Lomb.
Contact information
Radcliffe: nmr9003@med.cornell.edu
Robin: arobin@glaucomaexpert.com
Vold: svold@cox.net
Latanoprostene bunod
Bausch + Lomb's latanoprostene
bunod has shown noninferiority in
clinical studies when compared to
timolol, which is likely enough to
receive regulatory approval, but may
not be enough to warrant a mass
change on the part of prescribers,
Dr. Robin said.
"The drug is going to have to
prove superiority to other prosta-
glandins, not just to timolol," Dr.
Robin said. "If this drug can lower
IOP even 4 mm Hg better than
current prostaglandins, that will be a
persuasive argument."
Dr. Vold said he's cautiously op-
timistic about the potential prospect
of another new medication. "There's
a great deal of potential here, in that
latanoprostene bunod has a different
mechanism of action," he said.
The nitric oxide-donating aspect
"will increase outflow through the
trabecular meshwork," Dr. Radcliffe
said. "We expect to see a little bit
more potency from latanoprostene
bunod than we have with latano-
prost. I think more importantly,
we'll start thinking about whether or
not mechanism matters."
He continued: "If you think
about microinvasive glaucoma
Traditionally, medications reduce
aqueous production or improve
aqueous outflow, increase
uveoscleral outflow, or affect the
episcleral venous pressure. "We
now have the potential to have
one product that will cover all
four mechanisms of action."
–Steven Vold, MD
